title: Pattern of use of β-blockers in older patients with stable coronary artery disease: an observational, cross-sectional, multicentre survey.
abstract: BACKGROUND
  Several drugs, including β-blockers (β-adrenoceptor antagonists), are largely under-utilized in older patients with cardiovascular disease.
  
  
  OBJECTIVE
  The aims of this study were to evaluate whether older patients (aged ≥65 years) with coronary artery disease (CAD) have a different pattern of use of β-blockers than younger adult patients (aged <65 years) and whether gender differences or other clinical variables may influence the use of these drugs.
  
  
  METHODS
  Over 6 months, 2226 outpatients with stable CAD were enrolled in an observational, cross-sectional, multicentre survey. Of these, 1416 patients aged ≥65 years were grouped into four subgroups according to age. Predictors of β-blocker use were determined using logistic regression analyses. Comparisons between younger adults and older patients were conducted using Student's t-tests and chi-squared (χ2) tests.
  
  
  RESULTS
  Up to 47% of older patients were not receiving β-blockers, and this percentage progressively increased with age, with the oldest patients showing the lowest rate of utilization. No gender difference in the pattern of use of β-blockers was noted. The prescription of β-blockers was higher in patients with heart failure (HF) than in patients without HF. The presence of HF abolished the decrease in β-blocker use with age. Logistic regression analysis confirmed that lower age and severe HF were independent predictors of β-blocker use in older people.
  
  
  CONCLUSIONS
  Age appears to be a key factor in the under-prescription of β-blockers in CAD outpatients. Despite the recommendations, and the efforts of cardiologists, the use of β-blockers in the elderly is still limited, possibly because of practical constraints such as adverse effects and co-morbidity. In patients with HF, age is less important in determining the use of β-blockers.
authors.affiliation: Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy. cristiana.vitale@sanraffaele.it
authors.forename: Cristiana
authors.initials: C
authors.lastname: Vitale
authors.forename: Ilaria
authors.initials: I
authors.lastname: Spoletini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Volterrani
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Iellamo
authors.forename: Massimo
authors.initials: M
authors.lastname: Fini
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000319:Adrenergic beta-Antagonists