The early use of beta-blockers in patients with acute myocardial infarction reduces mortality and morbidity (ISIS-1, 1986; Goldstein, 1996; and MIAMI, 1985) and has demonstrated effectiveness in a wide range of AMI patients (Krumholz, 1998). National guidelines strongly recommend early beta-blockers for patients hospitalized with AMI (Braunwald, 2002 and Antman, 2004). Despite these recommendations, beta-blockers remain under-utilized in eligible older patients hospitalized with AMI (Jencks, 2000).

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• National Hospital Quality Measure Specifications Manual
• American Heart Association
• American College of Cardiology

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• Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004.
• Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, Jones RH, Kereiakes D, Kupersmith J, Levin TN, Pepline CJ, Schaeffer JW, Smith EE III, Steward DE, Theroux P. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). 2002.
• First International Study of Infarct Survival Collaborative Group. Randomized trial of intravenous atenolol among 16027 cases of suspected acute myocardial infarction: ISIS-1. Lancet. 1986;2:57-66.
• Goldstein S. β-blockers in hypertensive and coronary heart disease. Arch Intern Med. 1996;156:1267-76.
• Krumholz HM, Anderson JL, Brooks NH, Fesmir FM, Lambrew CT, Landrum MB, Weaver WD, Whyte J. ACC/AHA Clinical Performance Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction: a report of the ACC/AHA Task Force on Performance Measures (ST-Elevation and Non–ST-Elevation Myocardial Infarction Performance Measures Writing Committee). J Am Coll Cardiol 2006;47:236–65. Available at http://www.acc.org and http://www.americanheart.org.
• Jencks SJ, Cuerdon T, Burwen DR, Fleming B, Houck PM, Kussmaul AE, Nilasena DS, Ordin DL, Arday DR. Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels. JAMA. 2000;284:1670-1676.
• Krumholz HM, Radford MJ, Wang Y, Chen J, Heiat A, Marciniak TA. National use and effectiveness of β-blockers for the treatment of elderly patients after acute myocardial infarction. National Cooperative Cardiovascular Project. JAMA 1998;280:623-629.
• Metoprolol in acute myocardial infarction. Patient population. The MIAMI Trial Research Group. Am J Cardiol 1985; 56(14): 10G-14G.

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