title: Beta-blocker dosing in community-based treatment of heart failure.
abstract: BACKGROUND
  Community patients with heart failure (HF) are older, less often treated by HF specialists, and have more comorbidity than those in randomized clinical trials. These differences might affect beta-blocker prescribing in HF.
  
  
  METHODS
  To explore patterns of beta-blocker prescribing for HF in the community and their association with outcomes, we determined carvedilol doses at end titration in 4113 patients from a community-based beta-blocker HF registry according to physician and patient characteristics, HF severity, and rates of hospitalization and death.
  
  
  RESULTS
  Female sex, age > or = 65 years, and left ventricular ejection fraction > or = 35% were associated with lower beta-blocker doses. Average daily dose of beta-blocker was lower with worse baseline New York Heart Association class. More patients of cardiologists achieved carvedilol doses > or = 25 mg twice daily, whereas in those of noncardiologists lower doses were more common. Relative risk of HF hospitalizations or all-cause death was significantly lower with higher doses of beta-blocker.
  
  
  CONCLUSIONS
  Beta-blocker dosing in community HF appears lower than in randomized clinical trials, especially when prescribed by noncardiologists. At all doses, patients taking the beta-blocker carvedilol have a lower incidence of death and HF hospitalization than those discontinuing it, regardless of physician type in the community setting.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, CA, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Fowler
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Lottes
authors.forename: Jeanenne J
authors.initials: JJ
authors.lastname: Nelson
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Lukas
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: Barry
authors.initials: B
authors.lastname: Greenberg
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Franciosa
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D002227:Carbazoles / Q000008:administration & dosage*; D000077261:Carvedilol; D019058:Community Networks / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage*; D012720:Severity of Illness Index; D015996:Survival Rate; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol