title: Why do patients fail to receive beta-blockers for chronic heart failure over time? A "real-world" single-center, 2-year follow-up experience of beta-blocker therapy in patients with chronic heart failure.
abstract: BACKGROUND
  The longitudinal pattern of beta-blocker use in a heart-failure practice setting has not been explored. Previous studies have not specifically addressed the use of beta-blockers over time to determine the rate of use and reasons for discontinuation. The long-term compliance rate for beta-blocker drugs outside the context of a clinical trial has not been established.
  
  
  METHODS
  We prospectively followed a cohort of 500 consecutive patients between March and May 2001, with a clinical diagnosis of chronic heart failure seen in a specialized heart failure clinic and determined the longitudinal pattern of beta-blocker use and clinical outcomes over a 2-year period.
  
  
  RESULTS
  The final cohort consists of 340 patients with a complete 2-year follow-up data (mean age 61 +/- 14 years, 69% men, 53% with ischemic etiology, mean ejection fraction 27.6 +/- 15%). At 6, 12, and 24 months, beta-blocker utilization rates were maintained in 69%, 70%, and 74% of patients, respectively. Of the 120 confirmed initial non-beta-blocker users, 28 (23%) were subsequently started on beta-blocker, despite suspected relative contraindications in 53% of patients. Over a period of 2 years, the discontinuation rate was 10%, with failure to restart a beta-blocker after hospitalization as the most common reason for beta-blocker discontinuation.
  
  
  CONCLUSIONS
  Utilization rates of beta-blockers in our heart failure clinic have remained constant at approximately 70% throughout a 2-year follow-up. Of those who discontinued beta-blockers (10%), the most common documented cause was failure to restart beta-blockers after hospitalization.
authors.affiliation: Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Anoop C
authors.initials: AC
authors.lastname: Parameswaran
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Gary S
authors.initials: GS
authors.lastname: Francis
authors.forename: Ritesh
authors.initials: R
authors.lastname: Gupta
authors.forename: James B
authors.initials: JB
authors.lastname: Young
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol