***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To assess the relationship between use of & bgr;‐blockers and all‐cause mortality in patients with and without diabetes . Patients and Methods : Using data from the US National Health and Nutrition Examination Survey 1999‐2010 , we conducted a prospect i ve cohort study . The study participants were followed‐up from the survey participation date until December 31 , 2011 . We used a Cox proportional hazards model for all‐cause mortality analysis . The multivariate‐adjusted hazard ratios ( HRs ) of the participants taking & bgr;‐blockers were compared with those of the participants not taking & bgr;‐blockers . Results : This study included 2840 diabetic participants and 14,684 nondiabetic participants . Compared with diabetic participants not taking a & bgr;‐blocker  , all‐cause mortality was significantly higher in diabetic participants taking any & bgr;‐blocker ( HR , 1.49 ; 95 % CI , 1.09‐2.04 ; P=.01 ) , taking a & bgr;1‐selective & bgr;‐blocker ( HR , 1.60 ; 95 % CI , 1.13‐2.24 ; P=.007 ) , or taking a specific & bgr;‐blocker ( bisoprolol , metoprolol , and carvedilol ) ( HR , 1.55 ; 95 % CI , 1.09‐2.21 ; P=.01 ) . In addition , all‐cause mortality in  diabetic participants with coronary heart disease ( CHD ) was significantly higher in those taking beta‐blockers , compared with those not taking beta‐blockers ( HR , 1.64 ; 95 % CI , 1.08‐2.48 ; P=.02 ) , whereas that in non‐diabetic participants with CHD was significantly lower in those taking beta‐blockers ( HR , 0.68 ; 95 % CI , 0.50‐0.94 ; P=.02 ) . A propensity score – matched Cox proportional hazards model yielded similar results . Conclusion : Use of & bgr;‐blockers may be associated with an increased risk of mortality for patients with diabetes and among the subset who have CHD A multicenter double-blind r and omized study was carried out to compare the effect of timolol ( 10 mg twice daily ) with that of placebo in patients surviving acute myocardial infa rct ion . Treatment was started seven to 28 days after infa rct ion in 1884 patients ( 945 taking timolol , and 939 placebo ) , who represented 52 per cent of those evaluated for entry ; the patients were followed for 12 to 33 months ( mean , 17 ) . There were 152 deaths in the placebo group and 98 in the timolol group . When deaths that occurred during treatment or within 28 days of withdrawal were considered , the cumulated sudden-death rate over 33 months was 13.9 per cent in the placebo group and 7.7 per cent in the timolol group -- a reduction of 44.6 per cent ( P = 0.0001 ) . The cumulated reinfa rct ion rate was 20.1 per cent in the placebo group and 14.4 per cent in the timolol group ( P = 0.0006 ) . We conclude that long-term treatment with timolol in patients surviving acute myocardial infa rct ion reduces mortality and the rate of reinfa rct ion The effect of metoprolol on mortality and morbidity after 15 days , was compared with that of placebo in a double-blind r and omised international trial ( the MIAMI trial ) in patients with definite or suspected acute myocardial infa rct ion ( AMI ) . Treatment with intravenous metoprolol ( 15 mg ) or placebo was started shortly after the patient 's arrival in hospital within 24 h of the onset of symptoms , and then oral treatment ( 200 mg daily ) was continued for the study period ( 15 days ) . Of the 5778 patients included , 2901 were allocated to placebo and 2877 to metoprolol .  Definite AMI was confirmed in 4127 patients . There were 142 deaths in the placebo group ( 4.9 % ) and 123 deaths in the metoprolol group ( 4.3 % ) , a difference of 13 per cent with 95 per cent confidence limits of -8 to + 33 per cent , not statistically significant ( P = 0.29 ) . Previously recorded risk indicators of mortality were analysed in retrospect . These indicated that there was a category which showed higher risk which contained approximately 30 % of all r and omized patients . In these , the mortality rate in the metoprolol treated group was 29 % less than in the placebo group . In the remaining lower risk categories there was no difference between the treatment groups . This subset analysis must be interpreted with caution in view of the findings from other similar studies . Positive effects were observed on the incidence of definite AMI and on serum enzyme activity in patients treated early ( less than 7 h ) . There was no significant effect on ventricular fibrillation but the number of episodes tended to be lower in the metoprolol treated patients during the later phase ( 6 - 15 days ; 24 vs 54 episodes ) . The incidence of supraventricular tachyarrhythmias , the use of cardiac glycosides and other antiarrhythmics , and the need for pain-relieving treatment were significantly diminished by metoprolol amongst all r and omised patients .  Adverse events associated with metoprolol were infrequent , expected , and relatively mild The incidence of congestive heart failure was studied in the Beta Blocker Heart Attack Trial in which postmyocardial infa rct ion patients between the ages of 30 and 69 years , with no contraindication to propranolol  , were r and omly assigned to receive placebo ( n = 1921 ) or propranolol 180 or 240 mg daily ( n = 1916 ) 5 to 21 days after admission to the hospital for the event . Survivors of acute myocardial infa rct ion with compensated or mild congestive heart failure , including those on digitalis and diuretics , were included in the study . A history of congestive heart failure before r and omization characterized 710 ( 18.5 % ) patients : 345 ( 18.0 % ) in the propranolol group and 365 ( 19.0 % ) in the placebo group . The incidence of definite congestive heart failure after r and omization and during the study was 6.7 % in both groups . In patients with a history of congestive heart failure before r and omization , 51 of 345 ( 14.8 % ) in the propranolol group and 46 of 365 ( 12.6 % ) in the placebo group developed congestive heart failure during an average 25 month follow-up . In the patients with no history of congestive heart failure , 5 % in the propranolol group developed congestive heart failure and 5.3 % in the placebo group developed congestive heart failure . Baseline characteristics predictive of the occurrence of congestive heart failure by multivariate analyses included an increased cardiothoracic ratio , diabetes , increased heart rate , low baseline weight , prior myocardial infa rct ion , age , and more than 10 ventricular premature beats per hour . ( ABSTRACT TRUNCATED AT 250 WORDS Although clinical guidelines recommend long-term β-blocker ( BB ) therapy to decrease mortality after acute myocardial infa rct ion , these recommendations are based predominantly on evidence from before the reperfusion and thrombolytic eras . To investigate the effects of BB therapy for patients with acute myocardial infa rct ions on mortality in the percutaneous coronary intervention era , a total of 5,628 consecutive patients who were admitted < 24 hours after the onset of ST-segment elevation myocardial infa rct ion , treated with emergent percutaneous coronary intervention , and discharged alive were studied . During a median follow-up period of 1,430 days , mortality rates did not differ between patients with and without BB therapy ( 5.2 % vs 6.2 % , p = 0.786 ) . Multivariate analysis revealed that BB treatment was not associated with a reduced risk for mortality ( hazard ratio 0.935 , 95 % confidence interval 0.711 to 1.230 , p = 0.534 ) . The results of propensity score matching also indicated that the mortality rates did not differ between the 2 groups . However , subgroup analyses among matched population s revealed that BB treatment was associated with a significantly lower mortality risk for high-risk patients , who were defined as those with Global Registry of Acute Coronary Events ( GRACE ) risk scores ≥121 ( hazard ratio 0.596 , 95 % confidence interval 0.416 to 0.854 , p = 0.005 ) or those administered diuretics ( hazard ratio 0.602 , 95 % confidence interval 0.398 to 0.910 , p = 0.016 ) , but not for lower risk patients . In conclusion , BB treatment was associated with reduced long-term mortality in patients after ST-segment elevation myocardial infa rct ion at higher risk , but not in those at lower risk . Although r and omized controlled studies are warranted to confirm these results , the implementation of BB therapy for discharged patients with ST-segment elevation myocardial infa rct ion may need to be assessed on the basis of individual mortality risk in the percutaneous coronary intervention era OBJECTIVES We sought to determine the use and association with one-year mortality of beta-blocker therapy for the treatment of acute myocardial infa rct ion ( AMI ) in elderly diabetic patients and to examine whether beta-blocker therapy was associated with increased rates of hospital readmission for diabetic complications traditionally associated with beta-blockers . BACKGROUND Although many r and omized trials have demonstrated that beta-blockers are effective in reducing mortality after AMI , some experts are concerned about the use of beta-blockers in diabetic patients . Little is known about the effectiveness and complication rate of beta-blocker therapy after AMI for elderly diabetics in community practice setting s. METHODS We conducted a retrospective cohort study using the National Cooperative Cardiovascular Project , which contained data abstract ed from hospital medical records of Medicare beneficiaries admitted with an AMI during 1994 and 1995 . RESULTS Out of 45,308 patients without contraindications to beta-blocker therapy , 7.4 % were insulin-treated diabetics and 18.5 % were non-insulin-treated diabetics .  Beta-blockers were prescribed at discharge for 45 % of insulin-treated diabetics , 48.1 % of non-insulin-treated diabetics and 51 % of nondiabetics ( p < 0.001 ) . After adjusting for demographic and clinical factors , diabetics continued to be less likely to receive beta-blockers at discharge compared with nondiabetics ( odds ratio [ OR ] for insulin-treated diabetics 0.88 , 95 % confidence interval [ CI ] 0.82 to 0.96 ; OR for non-insulin-treated diabetics 0.93 , 95 % CI 0.88 to 0.98 ) . After adjusting for potential confounders , beta-blockers were associated with lower one-year mortality for insulin-treated diabetics ( hazard ratio [ HR ] = 0.87 , 95 % CI 0.72 to 1.07 ) , non-insulin-treated diabetics ( HR = 0.77 , 95 % CI 0.67 to 0.88 ) and nondiabetics ( HR = 0.87 , 95 % CI 0.80 to 0.94 ) . Beta-blocker therapy was not significantly associated with increased six-month readmission rates for diabetic complications among diabetics and nondiabetics . CONCLUSIONS Beta-blockers are associated with a lower one-year mortality rate for elderly diabetic patients to a similar extent as for nondiabetics , without increased risk of readmission for diabetic complications . Increasing the use of beta-blockers in elderly diabetic patients represents an opportunity to improve the care and outcomes of these patients after AMI In the Göteborg Metoprolol Trial , 1395 patients with suspected acute myocardial infa rct ion were , on admission , r and omly allocated to double-blind treatment , 697 to placebo and 698 to metoprolol ( 15 mg i.v . + 200 mg/day ) for 90 days . During this period , there were 62 deaths in the placebo group ( 8.9 % ) and 40 in the metoprolol group ( 5.7 % ) , a mortality reduction of 36 % ( p less than 0.03 ) . This effect persisted regardless of age , previous infa rct ion or previous chronic beta blockade . All deaths were classified as cardiovascular . After 3 months , all patients were recommended open treatment with metoprolol , and the difference in mortality between the two groups was maintained after 1 year . Early institution of metoprolol ( within 12 hours ) influenced infa rct development during the first 3 days ( infa rct diagnosis and indirect measures of infa rct size ) . Metoprolol also reduced the incidence on fatal and non 
    Output:
    
Conclusion BB therapy  in diabetic patients with stable CHD appears to be linked to higher mortality .