Underutilization of beta-blockers in patients undergoing implantable cardioverter-defibrillator and cardiac resynchronization procedures.
BACKGROUND
Current guidelines emphasize the need for optimal medical therapy before implantation of cardiac devices (implantable cardioverter-defibrillator, cardiac resynchronization therapy). Our objective was to evaluate use of beta-blockers (BB) among patients with heart failure undergoing a cardiac device procedure.


RESULTS
We used a large, multistate, managed-care database (January 2003 to December 2006) to identify adults admitted with an International Classification of Diseases, Ninth Revision (ICD-9) procedure code for cardiac device, continuous enrollment for 180 days before and 180 days after device procedure, and a primary or secondary ICD-9 diagnosis code for heart failure during that period. Our primary measures were use of BB before device procedure and changes after discharge. A total of 2766 beneficiaries (78.8% men; median age, 61 years) underwent a device procedure for primary prevention. The median number of days on BB therapy in the 90 days before device procedure was 46. Beneficiaries who did not have a pharmacy fill for BB during that time (n=925, 33.4%) were more elderly and had fewer antecedent outpatient visits with a cardiologist. There was a shift toward greater use of BB after device procedure; 83.4% had at least 1 pharmacy fill for a BB during follow-up.


CONCLUSIONS
BB are underused before and after cardiac device procedures. There is a modest increase in use after the procedure. Strategies are required to ensure that patients are on optimal medical therapy before device therapy is selected.
Hauptman
Paul J
PJ
Department of Medicine, Division of Cardiology, Saint Louis University School of Medicine, St Louis, MO 63110, USA. hauptmpj@slu.edu
Swindle
Jason P
JP
Masoudi
Frederick A
FA
Burroughs
Thomas E
TE
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D019992:Databases as Topic; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D011307:Drug Prescriptions; D004363:Drug Utilization; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000319:Adrenergic beta-Antagonists