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Underuse of -Blockers Following Myocardial Infarction

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To the Editor: The article by Dr Phillips and colleagues,¹ which estimated the cost-effectiveness of -blocker therapy in all patients with myocardial infarction, adds to literature documenting poor health outcomes associated with underuse of -blockers.² Although we agree with the conclusions that increased -blocker use would lead to impressive gains in health, we believe that the authors neglected to consider the costs of program implementation in their analysis.

Although the efficacy of -blockers has been known for more than 2 decades, -blockers continue to be underprescribed, even for ideal candidates.³ The authors point out that the reasons for underuse of -blocker therapy are complex and that multiple strategies would be required to increase -blocker utilization to target levels. However, the authors do not address the costs of such strategies in their analysis. Costs associated with measures to increase -blocker usage would likely include quality improvement initiatives, multidisciplinary team approaches, or . . . [Full Text of this Article]

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