Effect of a training program for primary care physicians on the optimization of beta-blocker treatment in elderly patients with heart failure.
OBJECTIVE
Underuse of betablockers may contribute to elevated mortality in chronic heart failure. The aim of this study was to determine whether a specific interventional training program for primary care physicians would help optimize the use of beta-blockers in elderly chronic heart failure patients.


METHODS
This randomized comparative study included 627 patients aged 70 years or more who were discharged consecutively from 53 Spanish hospitals with a principal diagnosis of chronic heart failure. In total, 292 health-care centers in the catchment areas of these hospitals were randomly assigned to two groups: one group of 146 centers carried out an interventional training program on beta-blocker use for primary care physicians belonging to the centers assigned to training, and 146 centers served as a control group. The main outcome variable was the percentage of patients who were receiving a beta-blocker at the maximum or maximum tolerated dose 3 months after hospital discharge.


RESULTS
The patients' mean age was 78+/-5 years and 42% were women. There was no difference between the groups in demographic characteristics, clinical care, or treatment at discharge. The percentage of patients who received beta-blockers at the maximum tolerated dose 3 months after discharge was greater in the training group (49% vs. 38%; P=.014). Being treated in the training group was an independent predictor of receiving a beta-blocker at the MTD (odds ratio=2.46; 95% confidence interval, 1.29-4.69; P< .001).


CONCLUSIONS
Implementation of an interventional training program on beta-blocker treatment for primary care physicians improved the use of these medications in elderly chronic heart failure patients.
Servicio de Cardiología, Hospital Reina Sofía, Córdoba, España. manuelp.anguita.sspa@juntadeandalucia.es
Manuel
M
Anguita Sánchez
Manuel
M
Jiménez-Navarro
Marisa
M
Crespo
Luis
L
Alonso-Pulpón
Eduardo
E
de Teresa
Alfonso
A
Castro-Beiras
Eulàlia
E
Roig
Remei
R
Artigas
Antonio
A
Zapata
Ignacio
I
López de Ulibarri
Javier
J
Muñiz
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002908:Chronic Disease; D004501:Education, Medical; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011320:Primary Health Care; D016037:Single-Blind Method
D000319:Adrenergic beta-Antagonists