title: Patterns of beta-blocker utilization in patients with chronic heart failure: experience from a specialized outpatient heart failure clinic.
abstract: BACKGROUND
  Beta-blockers have been shown incontrovertibly to improve morbidity and survival in patients with heart failure. However, there is limited information regarding their use in clinical practice settings, and reasonable utilization targets for quality improvement initiatives have not been established.
  
  
  METHODS
  We identified 500 consecutive patients with chronic heart failure seen at a specialized outpatient heart failure clinic from March 2001 to May 2001, and retrospectively extracted clinical and drug information from an electronic medical record.
  
  
  RESULTS
  In this cross-sectional analysis, the rate of beta-blocker utilization was 69%. Seventy-five percent of patients had at least tried a beta-blocker. Among those with beta-blockers initiated, 16% experienced side effects that led to drug discontinuation (9.1%) or down-titration (6.9%) that was similar across all NYHA classes. A lower utilization rate of beta-blockers was observed in patients of advanced age and those with diabetes mellitus, concomitant antiarrhythmic therapy, and preserved left ventricular ejection fraction (P <.05). Respiratory disease remained the most common reason for withholding beta-blocker therapy, especially with severe obstructive (rather than restrictive) physiology.
  
  
  CONCLUSIONS
  It appears that about 70% of patients with chronic heart failure can be successfully treated with a beta-blocker in a specialized heart failure outpatient setting where physicians are committed to beta-blocker use in heart failure. It is possible that subgroups with lower utilization rates can be targeted for quality improvement initiatives.
authors.affiliation: Department of Internal Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Gupta
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: James B
authors.initials: JB
authors.lastname: Young
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000554:Ambulatory Care Facilities; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D017723:Drug Utilization Review; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol