Why do patients fail to receive beta-blockers for chronic heart failure over time? A "real-world" single-center, 2-year follow-up experience of beta-blocker therapy in patients with chronic heart failure.

BACKGROUND: The longitudinal pattern of beta-blocker use in a heart-failure practice setting has not been explored. Previous studies have not specifically addressed the use of beta-blockers over time to determine the rate of use and reasons for discontinuation. The long-term compliance rate for beta-blocker drugs outside the context of a clinical trial has not been established.
METHODS: We prospectively followed a cohort of 500 consecutive patients between March and May 2001, with a clinical diagnosis of chronic heart failure seen in a specialized heart failure clinic and determined the longitudinal pattern of beta-blocker use and clinical outcomes over a 2-year period.
RESULTS: The final cohort consists of 340 patients with a complete 2-year follow-up data (mean age 61 +/- 14 years, 69% men, 53% with ischemic etiology, mean ejection fraction 27.6 +/- 15%). At 6, 12, and 24 months, beta-blocker utilization rates were maintained in 69%, 70%, and 74% of patients, respectively. Of the 120 confirmed initial non-beta-blocker users, 28 (23%) were subsequently started on beta-blocker, despite suspected relative contraindications in 53% of patients. Over a period of 2 years, the discontinuation rate was 10%, with failure to restart a beta-blocker after hospitalization as the most common reason for beta-blocker discontinuation.
CONCLUSION: Utilization rates of beta-blockers in our heart failure clinic have remained constant at approximately 70% throughout a 2-year follow-up. Of those who discontinued beta-blockers (10%), the most common documented cause was failure to restart beta-blockers after hospitalization.