Evidence map›Paper›PMID 10381708›Full record

SynthesisBMJ (Clinical research ed.)1999

beta Blockade after myocardial infarction: systematic review and meta regression analysis.

N Freemantle, J Cleland, P Young, J Mason, J Harrison

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 1999. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01365286 (Heart Rate Lowering Efficacy and Respiratory Safety of Ivabradine in Patients With Obstructive Airway Disease), which is not on this map. Cited by 328 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
328citing papers in PubMed, 17 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01365286 phase4completednot on this mapstarted 2009, after this paper: background citation

Heart Rate Lowering Efficacy and Respiratory Safety of Ivabradine in Patients With Obstructive Airway Disease

TypeinterventionalSponsorMedical University of LodzRan2009 to 2011Enrolled40ConditionsAsthma, Chronic Obstructive Pulmonary Disease (COPD)ArmsIvabradine (Procoralan), Placebo
3 · Its place in the literature

Who cites it

328 citing papers in PubMed, 17 syntheses or guidelines pooled it.

  1. Pooled it
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  5. Beta-blockers in patients without heart failure after myocardial infarction.The Cochrane database of systematic reviews · 2021
    Pooled it
  6. Beta-blockers for suspected or diagnosed acute myocardial infarction.The Cochrane database of systematic reviews · 2019
    Pooled it
  7. Pooled it
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  12. Guideline
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  17. Guideline
  18. βJournal of clinical pharmacology · 2019
    Trial
  19. Trial
  20. Trial

268 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

N FreemantleMedicines Evaluation Group, Centre for Health Economics, University of York, York YO10 5DD.
J Cleland
P Young
J Mason
J Harrison

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo assess the effectiveness of beta blockers in short term treatment for acute myocardial infarction and in longer term secondary prevention; to examine predictive factors that may influence outcome and therefore choice of drug; and to examine the clinical importance of the results in the light of current treatment.

designSystematic review of randomised controlled trials.

settingRandomised controlled trials. SUBJECTS: Patients with acute or past myocardial infarction.

interventionbeta Blockers compared with control.

main outcome measuresAll cause mortality and non-fatal reinfarction.

resultsOverall, 5477 of 54 234 patients (10.1%) randomised to beta blockers or control died. We identified a 23% reduction in the odds of death in long term trials (95% confidence interval 15% to 31%), but only a 4% reduction in the odds of death in short term trials (-8% to 15%). Meta regression in long term trials did not identify a significant reduction in effectiveness in drugs with cardioselectivity but did identify a near significant trend towards decreased benefit in drugs with intrinsic sympathomimetic activity. Most evidence is available for propranolol, timolol, and metoprolol. In long term trials, the number needed to treat for 2 years to avoid a death is 42, which compares favourably with other treatments for patients with acute or past myocardial infarction.

conclusionsbeta Blockers are effective in long term secondary prevention after myocardial infarction, but they are underused in such cases and lead to avoidable mortality and morbidity.

Indexed as

Adrenergic beta-AntagonistsHumansMyocardial InfarctionRandomized Controlled Trials as TopicRegression AnalysisTreatment OutcomeAdrenergic beta-Antagonists

Identifiers

PMID10381708
PMCPMC31101

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.