Patterns of β-blocker utilization in patients with chronic heart failure: experience from a specialized outpatient heart failure clinic
Abstract
Background Beta-blockers have been shown incontrovertibly to improve morbidity and survival in patients with heart failure. However, there is limited information regarding their use in clinical practice settings, and reasonable utilization targets for quality improvement initiatives have not been established.Method We identified 500 consecutive patients with chronic heart failure seen at a specialized outpatient heart failure clinic from March 2001 to May 2001, and retrospectively extracted clinical and drug information from an electronic medical record.Results In this cross-sectional analysis, the rate of beta-blocker utilization was 69%. Seventy-five percent of patients had at least tried a beta-blocker. Among those with beta-blockers initiated, 16% experienced side effects that led to drug discontinuation (9.1%) or down-titration (6.9%) that was similar across all NYHA classes. A lower utilization rate of beta-blockers was observed in patients of advanced age and those with diabetes mellitus, concomitant antiarrhythmic therapy, and preserved left ventricular ejection fraction (P <.05). Respiratory disease remained the most common reason for withholding beta-blocker therapy, especially with severe obstructive (rather than restrictive) physiology.Conclusion It appears that about 70% of patients with chronic heart failure can be successfully treated with a beta-blocker in a specialized heart failure outpatient setting where physicians are committed to beta-blocker use in heart failure. It is possible that subgroups with lower utilization rates can be targeted for quality improvement initiatives.
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Carvedilol is a widely used β-blocker in clinical practice.
“a widely used β-blocker in clinical practice, carvedilol (Gupta et al., 2004)”
From A Cardiovascular Disease-Linked Gut Microbial Metabolite Acts via Adrenergic Receptors (2020) · cites this paper as Gupta et al., 2004
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- Authors
- Gupta, R., Tang, W. H. W., & Young, J. B.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Young, James B
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2004-01
- Volume
- 147
- Issue
- 1
- Pages
- 79-83
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2094524567
- Cited by
- 45
- References
- 29
- Citations by year
- 2025: 1 · 2023: 1 · 2020: 4 · 2016: 3 · 2015: 1 · 2013: 1
- FWCI
- 3.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- beta-blockers, chronic heart failure, drug discontinuation, adverse drug reactions, quality improvement, outpatient heart failure clinic, respiratory diseases, obstructive lung disease, diabetes mellitus, antiarrhythmic therapy, left ventricular ejection fraction, NYHA functional class, elderly patients
- MeSH terms
- Carvedilol, Adrenergic beta-Antagonists, Age Factors, Aged, Ambulatory Care Facilities, Carbazoles, Chronic Disease, Cross-Sectional Studies, Female, Heart Failure, Humans, Male, Metoprolol, Middle Aged, Propanolamines, Respiratory Function Tests, Retrospective Studies, Sex Factors, Drug Utilization Review
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