Beta-blocker dosing in community-based treatment of heart failure.
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.
Fowler
Michael B
MB
Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, CA, USA.
Lottes
Sandra R
SR
Nelson
Jeanenne J
JJ
Lukas
Mary Ann
MA
Gilbert
Edward M
EM
Greenberg
Barry
B
Massie
Barry M
BM
Abraham
William T
WT
Franciosa
Joseph A
JA
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
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol