title: Prospective evaluation of beta-blocker use at the time of hospital discharge as a heart failure performance measure: results from OPTIMIZE-HF.
abstract: 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.
authors.affiliation: Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, California 90095-1679, USA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Wendy Gattis
authors.initials: WG
authors.lastname: Stough
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Barry H
authors.initials: BH
authors.lastname: Greenberg
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Jie Lena
authors.initials: JL
authors.lastname: Sun
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.forename: James B
authors.initials: JB
authors.lastname: Young
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors