Brief report: beta-blocker use among veterans with systolic heart failure.
BACKGROUND
Beta-blockers reduce mortality in patients with systolic chronic heart failure (CHF), yet prescription rates have remained low among primary care providers.


OBJECTIVE
To determine the beta-blocker prescription rate among patients with systolic CHF at primary care Veterans Affairs (VA) clinics, its change over time; and to determine factors associated with nonprescription.


METHODS
Retrospective chart review.


METHODS
Seven hundred and forty-five patients with diagnostic codes for CHF followed in primary care clinics at 3 urban VA Medical Centers.


METHODS
Rate of beta-blocker prescription and comparison of patient characteristics between those prescribed versus those not prescribed beta-blockers.


RESULTS
Only 368 (49%) had documented systolic CHF. Eighty-two percent (303/368) of these patients were prescribed a beta-blocker. The prescription rate rose steadily over 3 consecutive 2-year time periods. Patients with more severely depressed ejection fractions were more likely to be on a beta-blocker than patients with less severe disease. Independent predictors of nonprescription included chronic obstructive pulmonary disease, asthma, depression, and age. Patients under 65 years old were 12 times more likely to receive beta-blockers than those over 85.


CONCLUSIONS
Primary care providers at VA Medical Centers achieved high rates of beta-blocker prescription for CHF patients. Subgroups with relative contraindications had lower prescription rates and should be targeted for quality improvement initiatives.
Sinha
Sanjai
S
Department of Medicine, Bronx VA Medical Center, Bronx, NY, USA. sanjai.sinha@med.va.gov
Goldstein
Matthew
M
Penrod
Joan
J
Hochman
Tsivia
T
Kamran
Mohammad
M
Tenner
Craig
C
Cohen
Gabriela
G
Schwartz
Mark D
MD
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications; D002303:Cardiac Output, Low / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D000075202:Contraindications; D003863:Depression / Q000150:complications; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies; D013318:Stroke Volume; D013599:Systole; D014728:Veterans / Q000706:statistics & numerical data*
D000319:Adrenergic beta-Antagonists