Self-reported and actual beta-blocker prescribing for heart failure patients: physician predictors.
BACKGROUND
Beta-blockers reduce mortality among patients with systolic heart failure (HF), yet primary care provider prescription rates remain low.


OBJECTIVE
To examine the association between primary care physician characteristics and both self-reported and actual prescription of beta-blockers among patients with systolic HF.


METHODS
Cross-sectional survey with supplementary retrospective chart review.


METHODS
Primary care providers at three New York City Veterans Affairs medical centers.


METHODS
MAIN OUTCOMES WERE: 1) self-reported prescribing of beta-blockers, and 2) actual prescribing of beta-blockers among HF patients. Physician HF practice patterns and confidence levels, as well as socio-demographic and clinical characteristics, were also assessed.


RESULTS
Sixty-nine of 101 physicians (68%) completed the survey examining self-reported prescribing of beta-blockers. Physicians who served as inpatient ward attendings self-reported significantly higher rates of beta-blocker prescribing among their HF patients when compared with physicians who did not attend (78% vs. 58%; p = 0.002), as did physicians who were very confident in managing HF patients when compared with physicians who were not (82% vs. 68%; p = 0.009). Fifty-one of these 69 surveyed physicians (74%) were successfully matched to 287 HF patients for whom beta-blocker prescribing data was available. Physicians with greater self-reported rates of prescribing beta-blockers were significantly more likely to actually prescribe beta-blockers (p = 0.02); however, no other physician characteristics were significantly associated with actual prescribing of beta-blockers among HF patients.


CONCLUSIONS
Physician teaching responsibilities and confidence levels were associated with self-reported beta-blocker prescribing among their HF patients. Educational efforts focused on improving confidence levels in HF care and increasing exposure to teaching may improve beta-blocker presciption in HF patients managed in primary care.
Sinha
Sanjai
S
Department of Medicine, James J. Peters VA Medical Center, Bronx, New York, USA. Sanjai.Sinha@med.va.gov
Schwartz
Mark D
MD
Qin
Angie
A
Ross
Joseph S
JS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012044:Regression Analysis
D000319:Adrenergic beta-Antagonists