Trends and inequities in beta-blocker prescribing for heart failure.
BACKGROUND
Treatment with specific beta-blockers reduces mortality and hospitalisation in heart failure.


OBJECTIVE
To describe trends and inequities in beta-blocker prescribing for heart failure.


METHODS
Repeated cross-sectional analysis of a nationally representative primary care database (DIN-LINK).


METHODS
A total of 152 UK general practices.


METHODS
Prescribing of beta-blockers between 2000 and 2005 was examined among a yearly average of 7294 patients aged>or=50 years who had actively managed heart failure - defined as a recorded diagnosis of heart failure and two prescriptions of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker during the calendar year. The main outcome was the prescription of a guideline-recommended beta-blocker (bisoprolol, carvedilol, metoprolol, or nebivolol) in the year. Determinants of beta-blocker prescribing were analysed using logistic regression.


RESULTS
Between 2000 and 2005, age-adjusted use of recommended beta-blockers rose from 6.1% to 27.0% in men, and from 4.2% to 21.5% in women. In 2005, younger patients were more likely to be treated; the fully adjusted odds ratio was 4.83 (95% confidence interval=3.78 to 6.17) for patients aged 60-64 years compared with those aged 85 years. Women and patients living in areas of socioeconomic deprivation were less likely to be treated. In 2005, in addition to treatment with guideline-recommended beta-blockers, a further 11.7% of men and 12.5% of women were prescribed other beta-blockers.


CONCLUSIONS
Recommended beta-blocker use has risen in the UK but remains low and inequitable, with many patients still treated with beta-blockers that are not recommended in guidelines. This suggests further improvements in prescribing are still possible.
Shah
Sunil M
SM
Division of Community Health Sciences, St George's, University of London, Cranmer Terrace. sushah@sgul.ac.uk
Carey
Iain M
IM
DeWilde
Stephen
S
Richards
Nicky
N
Cook
Derek G
DG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000592:standards* / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000592:standards* / Q000639:trends; D012044:Regression Analysis
D000319:Adrenergic beta-Antagonists