title: Brief report: beta-blocker use among veterans with systolic heart failure.
abstract: 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.
authors.affiliation: Department of Medicine, Bronx VA Medical Center, Bronx, NY, USA. sanjai.sinha@med.va.gov
authors.forename: Sanjai
authors.initials: S
authors.lastname: Sinha
authors.forename: Matthew
authors.initials: M
authors.lastname: Goldstein
authors.forename: Joan
authors.initials: J
authors.lastname: Penrod
authors.forename: Tsivia
authors.initials: T
authors.lastname: Hochman
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kamran
authors.forename: Craig
authors.initials: C
authors.lastname: Tenner
authors.forename: Gabriela
authors.initials: G
authors.lastname: Cohen
authors.forename: Mark D
authors.initials: MD
authors.lastname: Schwartz
mesh_terms: 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*
chemical_list: D000319:Adrenergic beta-Antagonists