Patterns of beta-blocker utilization in patients with chronic heart failure: experience from a specialized outpatient heart failure clinic.

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.