Year of Publication

2015

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Philip Westgate, PhD

Committee Member

Daniela Moga, MD, PhD

Committee Member

Richard Kryscio, PhD

Abstract

OBJECTIVE – Beta-blockers remain important for secondary prevention after myocardial infarction (MI). Despite clinical guideline recommendations, the potential for poor glycemic control and masking warning signs of hypoglycemia limit their utilization in type 2 diabetes. This study evaluated factors predicting post-MI beta-blocker initiation among type 2 diabetic patients.

RESEARCH DESIGN AND METHODS – A retrospective cohort of employed, commercially insured individuals was developed using de-identified enrollment files, medical claims, and pharmacy claims from 2007-2009 in the U.S. Inclusion criteria: (1) type 2 diabetes, (2) ≥18 years old, (3) continuous eligibility, (4) MI. Exclusion criteria: (1) females prescribed metformin exclusively without diabetes diagnosis, (2) <6 months eligibility pre-MI, (3) MI before diabetes identified, (4) pre-MI beta-blocker, (5) receipt of sotalol post-MI, (6) no prescription claims, (7) <30 days between discharge and study end. Multivariable logistic regression with manual backward elimination was used to evaluate predictors of beta-blocker initiation.

RESULTS – Of 341 type 2 diabetic patients, only 167 (49.0%) initiated beta-blockers within 30 days of discharge. Patients on a calcium channel blocker (ORadj: 2.63) and patients taking 1 to 5 medications (ORadj: 3.59) were more likely to initiate beta-blockers post-MI. Patients with heart failure (ORadj: 0.45) or an arrhythmia (ORadj: 0.44) were less likely to initiate beta-blockers as well as patients with renal failure who are not taking a diuretic (ORadj: 0.17).

CONCLUSIONS – Although these results might not apply to older populations, they support the need for further investigation to determine whether more patients with type 2 diabetes could benefit from beta-blocker treatment post-MI.

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