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Relation of mortality to failure to prescribe beta blockers acutely in patients with sustained ventricular tachycardia and ventricular fibrillation following acute myocardial infarction (from the VALsartan In Acute myocardial iNfarcTion trial [VALIANT] Registry).
Am J Cardiol. 2008 Dec 01; 102(11):1427-32.AJ

Abstract

Sustained ventricular arrhythmias and heart failure are well-recognized complications after acute myocardial infarction (AMI) and have been associated with worse outcomes and increased mortality. The use of and outcomes associated with acute beta-blocker therapy in patients with AMI complicated by sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and heart failure were investigated. Of 5,391 patients in the VALIANT Registry, sustained VT/VF occurred in 306 (5.7%), with an in-hospital mortality rate of 20.3%. Multivariable logistic regression identified sustained VT/VF as a major predictor of in-hospital death (relative risk 4.18, 95% confidence interval 2.91 to 5.93). Of those with sustained VT/VF, 55.2% were treated with intravenous or oral beta blockade in the first 24 hours. After adjusting for baseline characteristics, propensity for acute beta-blocker use, and the interaction between Killip classification and beta-blocker therapy, beta-blocker therapy within 24 hours was associated with decreased in-hospital mortality in patients with sustained VT/VF (relative risk 0.28, 95% confidence interval 0.10 to 0.75, p = 0.013) without evidence of worsening heart failure. Patients with sustained VT/VF were less likely to receive beta blockers within 24 hours (p = 0.001). In conclusion, sustained VT/VF was common after AMI. In patients with sustained VT/VF, beta-blocker therapy in the first 24 hours after AMI was associated with decreased early mortality without worsening heart failure. Unfortunately, beta blockers were underused acutely in patients with sustained VT/VF.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. jonathan.piccini@duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19026290

Citation

Piccini, Jonathan P., et al. "Relation of Mortality to Failure to Prescribe Beta Blockers Acutely in Patients With Sustained Ventricular Tachycardia and Ventricular Fibrillation Following Acute Myocardial Infarction (from the VALsartan in Acute Myocardial iNfarcTion Trial [VALIANT] Registry)." The American Journal of Cardiology, vol. 102, no. 11, 2008, pp. 1427-32.
Piccini JP, Hranitzky PM, Kilaru R, et al. Relation of mortality to failure to prescribe beta blockers acutely in patients with sustained ventricular tachycardia and ventricular fibrillation following acute myocardial infarction (from the VALsartan In Acute myocardial iNfarcTion trial [VALIANT] Registry). Am J Cardiol. 2008;102(11):1427-32.
Piccini, J. P., Hranitzky, P. M., Kilaru, R., Rouleau, J. L., White, H. D., Aylward, P. E., Van de Werf, F., Solomon, S. D., Califf, R. M., & Velazquez, E. J. (2008). Relation of mortality to failure to prescribe beta blockers acutely in patients with sustained ventricular tachycardia and ventricular fibrillation following acute myocardial infarction (from the VALsartan In Acute myocardial iNfarcTion trial [VALIANT] Registry). The American Journal of Cardiology, 102(11), 1427-32. https://doi.org/10.1016/j.amjcard.2008.07.033
Piccini JP, et al. Relation of Mortality to Failure to Prescribe Beta Blockers Acutely in Patients With Sustained Ventricular Tachycardia and Ventricular Fibrillation Following Acute Myocardial Infarction (from the VALsartan in Acute Myocardial iNfarcTion Trial [VALIANT] Registry). Am J Cardiol. 2008 Dec 1;102(11):1427-32. PubMed PMID: 19026290.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relation of mortality to failure to prescribe beta blockers acutely in patients with sustained ventricular tachycardia and ventricular fibrillation following acute myocardial infarction (from the VALsartan In Acute myocardial iNfarcTion trial [VALIANT] Registry). AU - Piccini,Jonathan P, AU - Hranitzky,Patrick M, AU - Kilaru,Rakhi, AU - Rouleau,Jean-Lucien, AU - White,Harvey D, AU - Aylward,Philip E, AU - Van de Werf,Frans, AU - Solomon,Scott D, AU - Califf,Robert M, AU - Velazquez,Eric J, Y1 - 2008/09/11/ PY - 2008/04/03/received PY - 2008/07/15/revised PY - 2008/07/15/accepted PY - 2008/11/26/pubmed PY - 2008/12/23/medline PY - 2008/11/26/entrez SP - 1427 EP - 32 JF - The American journal of cardiology JO - Am J Cardiol VL - 102 IS - 11 N2 - Sustained ventricular arrhythmias and heart failure are well-recognized complications after acute myocardial infarction (AMI) and have been associated with worse outcomes and increased mortality. The use of and outcomes associated with acute beta-blocker therapy in patients with AMI complicated by sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and heart failure were investigated. Of 5,391 patients in the VALIANT Registry, sustained VT/VF occurred in 306 (5.7%), with an in-hospital mortality rate of 20.3%. Multivariable logistic regression identified sustained VT/VF as a major predictor of in-hospital death (relative risk 4.18, 95% confidence interval 2.91 to 5.93). Of those with sustained VT/VF, 55.2% were treated with intravenous or oral beta blockade in the first 24 hours. After adjusting for baseline characteristics, propensity for acute beta-blocker use, and the interaction between Killip classification and beta-blocker therapy, beta-blocker therapy within 24 hours was associated with decreased in-hospital mortality in patients with sustained VT/VF (relative risk 0.28, 95% confidence interval 0.10 to 0.75, p = 0.013) without evidence of worsening heart failure. Patients with sustained VT/VF were less likely to receive beta blockers within 24 hours (p = 0.001). In conclusion, sustained VT/VF was common after AMI. In patients with sustained VT/VF, beta-blocker therapy in the first 24 hours after AMI was associated with decreased early mortality without worsening heart failure. Unfortunately, beta blockers were underused acutely in patients with sustained VT/VF. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/19026290/Relation_of_mortality_to_failure_to_prescribe_beta_blockers_acutely_in_patients_with_sustained_ventricular_tachycardia_and_ventricular_fibrillation_following_acute_myocardial_infarction__from_the_VALsartan_In_Acute_myocardial_iNfarcTion_trial_[VALIANT]_Registry__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(08)01257-5 DB - PRIME DP - Unbound Medicine ER -