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Patients who would benefit most from ?-blockers are least often receiving them, according to new research.

Less than half of patients recovering from a heart attack and only 12 per cent of those over the age of 80 were receiving the drugs. Patients with peripheral vascular disease, diabetes, heart failure and airways disease were also under-treated, according to the study of 865 post-MI patients.

But adherence of over 80 per cent halved mortality overall and decreased it by 60 per cent in patients at highest cardiovascular risk.

The researchers urged GPs to trial patients on ?-blockers for secondary prevention of MI even if they had 'relative' contraindications.

Study leader Professor Tom MacDonald, professor of clinical pharmacology and therapeutics at the University of Dundee, said: 'Those at highest risk are most likely to benefit. We have to give people the opportunity to have side-effects and decide to stop treatment themselves.'

Dr Stewart Findlay, a GP in Bishop Auckland, County Durham, and member of the steering group of the Primary Care Cardiovascular Society, agreed GPs should try ?-blockers when patients had 'relative' contraindications.

Dr Findlay said the Q&O framework might reduce inequalities in prescribing, although 'unfortunately there's no indicator for the use of ?-blockers in heart failure'.

The study, of record-linked data in Tayside, Scotland, was published online in Pharmaco-epidemiology and Drug Safety.

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