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Invited Commentary
Less Is More
February 2017

Guideline-Based Prescribing in Frail Elderly Patients

Author Affiliations
  • 1Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester

Copyright 2016 American Medical Association. All Rights Reserved.

JAMA Intern Med. 2017;177(2):262-263. doi:10.1001/jamainternmed.2016.7714

In this issue of JAMA Internal Medicine, Steinman and colleagues1 report on their carefully designed observational study of the comparative benefits and harms of β-blocker use for acute myocardial infarction (AMI) in adults 85 years or older—a population for whom no evidence from randomized clinical trials exists. They found that, within 3 months of hospital discharge after AMI, 12.1% of their study population experienced functional decline, 25.3% were rehospitalized, and 14.1% died. Use of β-blockers decreased the odds of death regardless of functional status. This should be good news. Guideline-based medications for AMI have been underused in older adults. The study’s confirmation of the survival benefit for frail elders will likely spur an increase in β-blocker prescribing for older adults with multiple comorbidities.