• David D Vega, Kendra L Dolan, and Marc L Pollack.
• Department of Emergency Medicine, York Hospital, York, PA 17405, USA. dvega@wellspan.org
• Am J Emerg Med. 2006 Jul 1; 24 (4): 435-9.

BackgroundDespite the effectiveness of early beta-blocker (BB) use in reducing mortality in acute myocardial infarction (AMI), they remain underutilized in the emergency department (ED) management of AMI. The elderly, with higher AMI mortality, and women, may be particularly vulnerable to underutilization of BB.ObjectiveTo determine the effect of age and gender on BB use in AMI in the ED.MethodsA retrospective study of all ST-elevation AMI (STEMI) ED patients presenting to a community hospital ED from 2001 to 2003. Any contraindication to BB use (hypotension, bradycardia, AV block, active bronchospasm, and active congestive heart failure) was determined. Chi-square analysis was used to determine differences by gender and age.ResultsThree hundred eighty-five patients with STEMI were identified. Thirty-eight percent were women and 71% were over 60 years of age. Of the 270 (70%) who did not receive BB, 141 (52%) had contraindications to BB use. The total BB eligible group was 244 (63%). Of patients without contraindications to BB, 53% did not receive BB in the ED. By gender, 83 (54%) males and 46 (51%) females did not receive BB (P=.669). By age, 96 subjects (59%) over age 60 and 33 subjects (41%) under age 60 did not receive BB (P=.011).ConclusionDespite convincing evidence of effectiveness, BB remain underutilized in ED management of AMI, especially in the elderly. There does not appear to be a gender difference in BB use. Education programs should be directed towards emergency physicians regarding BB use in AMI, especially in elderly ED patients.

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