Prospective evaluation of beta-blocker use at the time of hospital discharge as a heart failure performance measure: results from OPTIMIZE-HF.
BACKGROUND
The objective of this study was to prospectively evaluate beta-blocker use at hospital discharge as an indicator of quality of care and outcomes in patients with heart failure (HF).


RESULTS
Data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry for patients hospitalized with HF from 259 hospitals were prospectively collected and analyzed. HF medication contraindications, intolerance, and use at hospital discharge were assessed, along with 60- to 90-day follow-up data in a prespecified cohort. There were 20,118 patients with left ventricular systolic dysfunction. At discharge, 90.6% of patients were eligible to receive beta-blockers, and 83.7% were eligible to receive an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Eligible patients discharged with beta-blockers were significantly more likely to be treated at follow-up than those not discharged with beta-blockers (93.1% vs 30.5%; P < .0001). Discharge use of beta-blockers in eligible patients was associated with a significant reduction in the adjusted risk of death (hazard ratio: 0.48; 95% confidence interval: 0.32-0.74; P < .001) and death/rehospitalization (odds ratio: 0.74; 95% confidence interval: 0.55-0.99; P = .04), although we cannot completely exclude the possibility of residual confounding.


CONCLUSIONS
Discharge beta-blocker use in HF appeared to be well tolerated, improved treatment rates, and was associated with substantially lower postdischarge mortality risk. These data provide additional evidence that supports beta-blocker use at hospital discharge in eligible patients as an HF performance measure.
Fonarow
Gregg C
GC
Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, California 90095-1679, USA.
Abraham
William T
WT
Albert
Nancy M
NM
Stough
Wendy Gattis
WG
Gheorghiade
Mihai
M
Greenberg
Barry H
BH
O'Connor
Christopher M
CM
Sun
Jie Lena
JL
Yancy
Clyde W
CW
Young
James B
JB
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors