Factors associated with β-blocker initiation and discontinuation in a population-based cohort of seniors newly diagnosed with heart failure.
OBJECTIVE
β-Blockers (bisoprolol, carvedilol, and metoprolol) are the cornerstone of heart failure (HF) management. The incidence rate of β-blocker initiation and discontinuation and their associated factors among seniors with a first HF diagnosis were assessed.


METHODS
A population-based inception cohort study that included all individuals aged ≥65 years with a first HF diagnosis in Quebec was conducted. β-Blockers initiation among 91,131 patients who were not using β-blockers at the time of HF diagnosis and discontinuation among those who initiated a β-blocker after HF diagnosis were assessed. Stepwise Cox regression analyses were used to calculate hazard ratios (HR) and to identify factors associated with β-blocker initiation and discontinuation.


RESULTS
After HF diagnosis, 32,989 (36.2%) individuals initiated a β-blocker. Of these, 15,408 (46.7%) discontinued their β-blocker during the follow-up. Individuals more likely to initiate a β-blocker were those diagnosed in a recent calendar year (2009: HR, 2.11; 95% confidence interval [CI], 2.00-2.23) and diagnosed by a cardiologist (HR, 1.38; 95% CI, 1.34-1.42). Individuals less likely to initiate were those aged ≥90 years (HR, 0.65; 95% CI, 0.61-0.68) and those with chronic obstructive pulmonary disease (HR, 0.66; 95% CI, 0.64-0.68). Individuals more likely to discontinue were those with more than nine medical consultations (HR, 1.14; 95% CI, 1.10-1.18) and those with dementia (HR, 1.13; 95% CI, 1.01-1.27). Individuals less likely to discontinue were those diagnosed in a recent calendar year (2009: HR 0.74; 95% CI, 0.65-0.82) and those exposed to another β-blocker before HF diagnosis (HR, 0.88; 95% CI, 0.85-0.91).


CONCLUSIONS
Quebec seniors seem to be underexposed to β-blocker following HF diagnosis. Among those who initiate β-blocker use, discontinuation is high. Better understanding of the underlying causes is needed to help target interventions to improve the management of HF.
Chair on Adherence to Treatments, Université Laval; Faculty of Pharmacy, Université Laval; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center.
Catherine
C
Girouard
Chair on Adherence to Treatments, Université Laval; Faculty of Pharmacy, Université Laval; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center.
Jean-Pierre
JP
Grégoire
Faculty of Pharmacy, Université Laval; Quebec Heart and Lung Institute-Université Laval, Quebec City, QC, Canada.
Paul
P
Poirier
Chair on Adherence to Treatments, Université Laval; Faculty of Pharmacy, Université Laval; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center.
Jocelyne
J
Moisan
cohort study; drug use; heart failure; β-blocker discontinuation; β-blocker initiation
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