Predictors of β-blocker initiation after myocardial infarction in patients with type 2 diabetes: A retrospective study of a privately insured US population

Ryan P. Hickson, Candace J. Brancato, Daniela C. Moga

Research output: Contribution to journalArticlepeer-review


Background: Beta-blockers remain important for secondary prevention after myocardial infarction (MI). Despite clinical guideline recommendations, underutilization of this pharmacotherapy continues in patients with type 2 diabetes (T2DM) compared to the general post-MI population. Objective: This study aimed to (1) quantify the proportion of T2DM patients utilizing β-blocker therapy within 30 days of hospital discharge after MI and (2) identify clinical and demographic characteristics predicting initiation of β-blocker therapy. Methods: A retrospective cohort of US employed, commercially insured individuals was assembled using de-identified enrollment files, medical claims, and pharmacy claims from 2007 to 2009. Inclusion criteria were the following: (1) type 2 diabetes, (2) ≥18 years old, (3) continuous eligibility, (4) MI. Multivariable logistic regression with adjusted odds ratios (ORadj) using manual backward elimination was used to identify predictors of β-blocker initiation within 30 days of discharge from index hospitalization. Results: Of 341 T2DM patients, 167 (49.0%) were new users and 174 (51.0%) were nonusers of β-blockers within 30 days of post-MI hospital 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 β-blockers post-MI. Patients with heart failure (ORadj 0.45) or an arrhythmia (ORadj 0.44) were less likely to initiate β-blockers as well as patients with renal failure not taking a diuretic (ORadj 0.17). Conclusions: These results confirm previous findings that β-blockers are underutilized in T2DM patients post-MI. Predictors from the regression model can guide future research investigating how this deviation from guidelines is attributed to prescriber versus patient behavior.

Original languageEnglish
Pages (from-to)160-168
Number of pages9
JournalJournal of Pharmacy Technology
Issue number4
StatePublished - Aug 2016

Bibliographical note

Funding Information:
This project was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000117-02. Dr Hickson is supported by the American Foundation for Pharmaceutical Education as the 2015 Phi Lambda Sigma First Year Graduate School Fellow. Dr Moga is supported by Grant Number K12 DA035150 from the National Institutes of Health, Office of Women's Health Research, and the National Institute on Drug Abuse.

Publisher Copyright:
© 2016 The Author(s).


  • Myocardial infarction
  • Preventative medicine
  • Standards of practice
  • Type 2 diabetes
  • β-adrenergic blockers

ASJC Scopus subject areas

  • Pharmaceutical Science


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