BACKGROUND: Although beta-blockers are known to prolong survival for patients with reduced left ventricular ejection fraction, they are often underused. We hypothesized that a reminder attached to the echocardiography report would increase the use of beta-blockers for patients with reduced left ventricular ejection fraction. METHODS AND RESULTS: We randomized 1546 consecutive patients with a left ventricular ejection fraction <45% found on echocardiography at 1 of 3 laboratories to a reminder for use of beta-blockers or no reminder. Patients were excluded from analysis if they died within 30 days of randomization (n=89), did not receive medications through the Veterans Affairs system after 30 days (n=180), or underwent echocardiography at >1 laboratory (n=6). The primary outcome was a prescription for an oral beta-blocker between 1 and 9 months after randomization. The mean age of the 1271 included patients was 69 years; 60% had a history of heart failure, and 51% were receiving treatment with beta-blockers at the time of echocardiography. More patients randomized to the reminder had a subsequent beta-blocker prescription (74%, 458 of 621) compared with those randomized to no reminder (66%, 428 of 650; P=0.002). The effect of the reminder was not significantly different for subgroups based on patient location (inpatient versus outpatient) or prior use of beta-blockers. CONCLUSIONS: A reminder attached to the echocardiography report increased the use of beta-blockers in patients with depressed left ventricular systolic function.
RCT Entities:
BACKGROUND: Although beta-blockers are known to prolong survival for patients with reduced left ventricular ejection fraction, they are often underused. We hypothesized that a reminder attached to the echocardiography report would increase the use of beta-blockers for patients with reduced left ventricular ejection fraction. METHODS AND RESULTS: We randomized 1546 consecutive patients with a left ventricular ejection fraction <45% found on echocardiography at 1 of 3 laboratories to a reminder for use of beta-blockers or no reminder. Patients were excluded from analysis if they died within 30 days of randomization (n=89), did not receive medications through the Veterans Affairs system after 30 days (n=180), or underwent echocardiography at >1 laboratory (n=6). The primary outcome was a prescription for an oral beta-blocker between 1 and 9 months after randomization. The mean age of the 1271 included patients was 69 years; 60% had a history of heart failure, and 51% were receiving treatment with beta-blockers at the time of echocardiography. More patients randomized to the reminder had a subsequent beta-blocker prescription (74%, 458 of 621) compared with those randomized to no reminder (66%, 428 of 650; P=0.002). The effect of the reminder was not significantly different for subgroups based on patient location (inpatient versus outpatient) or prior use of beta-blockers. CONCLUSIONS: A reminder attached to the echocardiography report increased the use of beta-blockers in patients with depressed left ventricular systolic function.
Authors: Anubha Agarwal; Ehete Bahiru; Sang Gune Kyle Yoo; Mark A Berendsen; Sivadasanpillai Harikrishnan; Adrian F Hernandez; Dorairaj Prabhakaran; Mark D Huffman Journal: Heart Date: 2019-01-30 Impact factor: 5.994
Authors: Brian J Hemens; Anne Holbrook; Marita Tonkin; Jean A Mackay; Lorraine Weise-Kelly; Tamara Navarro; Nancy L Wilczynski; R Brian Haynes Journal: Implement Sci Date: 2011-08-03 Impact factor: 7.327
Authors: Hisham Dokainish; Lauren Jewett; Robby Nieuwlaat; Joshua Coulson; Catherine Demers; Eva Lonn; Jeff Healey; Brian Haynes; Stuart Connolly Journal: Open Cardiovasc Med J Date: 2014-09-30