title: Clinical reminders attached to echocardiography reports of patients with reduced left ventricular ejection fraction increase use of beta-blockers: a randomized trial.
abstract: BACKGROUND
  Although beta-blockers are known to prolong survival for patients with reduced left ventricular ejection fraction, they are often underused. We hypothesized that a reminder attached to the echocardiography report would increase the use of beta-blockers for patients with reduced left ventricular ejection fraction.
  
  
  RESULTS
  We randomized 1546 consecutive patients with a left ventricular ejection fraction <45% found on echocardiography at 1 of 3 laboratories to a reminder for use of beta-blockers or no reminder. Patients were excluded from analysis if they died within 30 days of randomization (n=89), did not receive medications through the Veterans Affairs system after 30 days (n=180), or underwent echocardiography at >1 laboratory (n=6). The primary outcome was a prescription for an oral beta-blocker between 1 and 9 months after randomization. The mean age of the 1271 included patients was 69 years; 60% had a history of heart failure, and 51% were receiving treatment with beta-blockers at the time of echocardiography. More patients randomized to the reminder had a subsequent beta-blocker prescription (74%, 458 of 621) compared with those randomized to no reminder (66%, 428 of 650; P=0.002). The effect of the reminder was not significantly different for subgroups based on patient location (inpatient versus outpatient) or prior use of beta-blockers.
  
  
  CONCLUSIONS
  A reminder attached to the echocardiography report increased the use of beta-blockers in patients with depressed left ventricular systolic function.
authors.affiliation: Palo Alto VA Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA. heiden@stanford.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Parisa
authors.initials: P
authors.lastname: Gholami
authors.forename: Anju
authors.initials: A
authors.lastname: Sahay
authors.forename: Barry
authors.initials: B
authors.lastname: Massie
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D004452:Echocardiography; D034742:Electronic Mail; D006801:Humans; D007619:Kartagener Syndrome / Q000453:epidemiology*; D008297:Male; D008790:Metoprolol / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy*; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol