Beta-blockers are a cornerstone of treatment following acute myocardial infarction, but many older nursing home residents don’t receive them owing to concerns over functional harms, such as dizziness, fatigue and depression.
Reporting their findings in JAMA Internal Medicine
(online, 12 December 2016), researchers studied 5,496 nursing home residents who began taking a beta-blocker after an acute myocardial infarction, matched to an equal number of residents with similar characteristics who did not receive beta-blockers.
Among those with pre-existing substantial cognitive or functional impairment, beta-blocker users had a 34% increased risk of functional decline. But functional decline was unaffected by beta-blocker use in those with relatively preserved baseline cognition and function. Mortality was 26% lower in beta-blocker users and this was similar across all subgroups.
The researchers conclude that this trade-off between functional harms and mortality benefits should be resolved on individual patient preferences rather than generally withholding beta-blocker treatment for older patients.
 Steinman MA, Zullo AR, Lee Y et al. Association of Î²-blockers with functional outcomes, death, and rehospitalization in older nursing home residents after acute myocardial infarction. JAMA Internal Medicine 2016; doi: 10.1001/jamainternmed.2016.7701