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UMMS experts discuss prescribing of beta-blockers to elderly in JAMA editorial

By Sarah Willey

UMass Medical School Communications

December 12, 2016
  Kate Lapane, PhD

Kate Lapane, PhD

  Jennifer Tjia, MD

Jennifer Tjia, MD 

Beta-blockers are one of the most widely prescribed classes of drugs used to treat Americans who have suffered a heart attack. But new research is raising the issue that less may be more when treating the vulnerable population of frail older adults.

Geriatric palliative care experts Jennifer Tjia, MD, MSCE, associate professor of quantitative health sciences, and Kate Lapane, PhD, professor of quantitative health sciences and associate dean of clinical and population health research, published an editorial in the Dec. 12 issue of JAMA Internal Medicine in response to a paper on the use of beta-blockers in people 85 and older. Researchers at the University of California San Francisco used observational data to examine the outcomes of prescribing the drugs to frail, elderly patients at high-risk. In the editorial, Dr. Tjia explains that the study’s findings paint a complicated picture.

“This well-executed paper provides evidence that following current guidelines to prescribe beta-blockers after a heart attack can reduce mortality rate in adults 85 and older, but the study also found beta-blockers can cause harm in some by increasing functional and cognitive decline,” Tjia said.

Tjia and Dr. Lapane’s primary research focus is medication issues among the elderly. In the editorial, they point out that there is not enough evidence based on clinical trials to guide medication use in frail, older people. They also explained that clinicians must look beyond the findings addressed in the paper.

“Good prescribing is a balancing act, and as clinicians, when we start a patient on a medication, we need to think about when we are going to stop it,” Tjia said. “We need to have frank conversations with patients and family members, because beta-blockers may work for some, but for others they can cause harmful side effects that do not improve quality of life.” 

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