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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
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.