Beta Blockers After Myocardial Infarction Essay

3431 words - 14 pages

Beta Blockers After Myocardial Infarction
Clinical Scenario
The acute care nurse practitioner on the cardiology service treats a 67 year-old-male admitted after recovering from an acute ST-Elevation Myocardial Infarction (STEMI). His risk factors include obesity, Type II diabetes mellitus, and family history. Upon exam the patient asks why he has not been started on a beta blocker yet. He explains further that when his brother had a “heart attack” in 2005, he was immediately placed on a beta blocker because the cardiologist reported how beta blockers reduce mortality after myocardial infarction (MI). The patient wants to know if a beta blocker would reduce his chance of mortality? Using ...view middle of the document...

* This article was an individual randomized control trial reporting findings in narrow confidence intervals, thus earning a level of evidence of 1b when applying the CEBM scale ("Oxford centre," 2009).
Article critique.
* The title and abstract were identified this article as a randomized controlled trial.
* Abstract and introduction were organized well, stressing purpose, methods and results.
* Randomized and controlled design with a metoprolol group and a control placebo group. Patients were blinded, but there was no mention of blinding researchers.
* Inclusion, exclusion, and study settings were described.
* Experimental and control groups were treated the same.
* Low numbers were lost to follow-up, although about 10% of those studied were excluded because they were not compliant with medication in an outpatient setting.
* Results show the groups had no significant differences in mortality.
* Subjects receiving metoprolol had fewer adverse events of ventricular fibrillation and reinfarction groups, but this was offset by an increase in cardiogenic shock episodes.
Clinical scenario relevance.
* This study applies to our clinical question by showing no significant difference in mortality after MI in those treated with or without metoprolol.
Primary Article Two
Article selection and evidence.
* The article by Wienbergen et al. (2007) was selected because it was specific our PICO question in evaluating beta blocker use during MI episodes and evaluating the outcomes.
* This was a progressive cohort study, evaluating the therapies physicians selected when treating patients during STEMI event, and the subsequent outcomes. The level of evidence is 2b when applying the CEBM scale ("Oxford centre," 2009).
Article critique.
* Abstract and introduction were organized well, stressing purpose, methods and results.
* Inclusion, exclusion, and study settings were described.
* Progressive cohort study design. One acute STEMI group received aspirin, ACE-Inhibitor and a beta blocker, while the other only received aspirin and ACE-Inhibitor.
* Assignment of intervention group was not controlled by the researcher, resulting in the beta blocker group being much larger in size than the non-beta blocker group.
* Treatment groups not treated the same. For example, more participants from the beta blocker group received a percutaneous coronary intervention (PCI).
* Significantly less mortality seen in the beta blocker group, 4.9% compared to 10.8%.
Clinical scenario relevance.
* This information could be applied to the STEMI patient in our scenario, but with caution. This is because the level of evidence could have been stronger, there was room for confounding factors and groups were not treated equally.
Primary Article Three
Article selection and evidence.
* The article by Halkin et al. (2004) was selected because the subject matter was specific to giving a beta blocker...

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