Outcomes of Beta-Blocker Use Elderly With Diabetes After Heart Attack

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Carvedilol, nebivolol, and labetalol were considered to be “T2D-friendly” beta-blockers for patients after acute myocardial infarction.
Carvedilol, nebivolol, and labetalol were considered to be “T2D-friendly” beta-blockers for patients after acute myocardial infarction.

Beta-blockers like carvedilol, nebivolol, and labetalol are associated with fewer hospitalizations for hyperglycemia but increased all-cause rehospitalizations among nursing home residents with diabetes and recent acute myocardial infarction, according to research published in Diabetes, Obesity & Metabolism.

Using Medicare data from 2007 to 2010, researchers conducted a retrospective cohort study of long-stay nursing home residents with type 2 diabetes who were prescribed diabetes-friendly beta-blockers (carvedilol, nebivolol, and labetalol) vs diabetes-unfriendly beta-blockers (atenolol, bisoprolol, and metoprolol) after experiencing an acute myocardial infarction. Beta-blockers were characterized as friendly or unfriendly based on vasodilation properties.

Out of 15,720 nursing home residents, 8953 (56.9%) were started on a beta-blocker after acute myocardial infarction and readmission into their nursing home. Of these nursing home residents started on beta-blockers, 59.9% had type 2 diabetes.  In addition, 29% (n=815/2855) of nursing home residents with type 2 diabetes initiated a diabetes-friendly beta-blocker.

Nursing home residents who were prescribed diabetes-friendly beta-blockers had a significantly lower likelihood of hospitalization for hyperglycemia when compared with nursing home residents who took diabetes-unfriendly beta-blockers (odds ratio [OR] 0.45, 95% CI 0.21-0.97). There was no impact observed for hypoglycemia. There were also no significant differences found between beta-blockers related to functional decline, death, or fracture hospitalization. However, nursing home residents who were prescribed diabetes-friendly beta-blockers had a significant increase in all-cause rehospitalizations (OR 1.26, 95% CI 1.01-1.57).

Limitations of the research include confounding factors related to the choice of beta-blockers studied, lack of data regarding information on HbA1c, limited statistical power, and issues with generalizability.

Study authors conclude that “[diabetes-friendly] beta-blockers were associated with a reduction in hospitalization for hyperglycemia and an increase in all-cause rehospitalization. Given that in addition to all-cause rehospitalization, [diabetes-friendly] beta-blockers may also be associated with other detrimental effects that were unmeasured in the current study, they should not be preferentially prescribed despite their potential advantage for glycemic control.”

This study was supported by the National Heart, Lung, and Blood Institute and the National Institute on Aging. Study authors note affiliation and individual support by other federal agencies. Please refer to reference for complete details.

Reference

Zullo AR, Hersey M, Lee Y, et al. Outcomes of “diabetes-friendly” versus “diabetes-unfriendly” beta-blockers in older nursing home residents with diabetes after acute myocardial infarction [published online June 28, 2018]. Diabetes Obes Metab. doi: 10.1111/dom.13451

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