BACKGROUND: Treatment with specific beta-blockers reduces mortality and hospitalisation in heart failure. AIM: To describe trends and inequities in beta-blocker prescribing for heart failure. DESIGN OF STUDY: Repeated cross-sectional analysis of a nationally representative primary care database (DIN-LINK). SETTING: A total of 152 UK general practices. METHOD: Prescribing of beta-blockers between 2000 and 2005 was examined among a yearly average of 7294 patients aged>or=50 years who had actively managed heart failure - defined as a recorded diagnosis of heart failure and two prescriptions of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker during the calendar year. The main outcome was the prescription of a guideline-recommended beta-blocker (bisoprolol, carvedilol, metoprolol, or nebivolol) in the year. Determinants of beta-blocker prescribing were analysed using logistic regression. RESULTS: Between 2000 and 2005, age-adjusted use of recommended beta-blockers rose from 6.1% to 27.0% in men, and from 4.2% to 21.5% in women. In 2005, younger patients were more likely to be treated; the fully adjusted odds ratio was 4.83 (95% confidence interval=3.78 to 6.17) for patients aged 60-64 years compared with those aged 85 years. Women and patients living in areas of socioeconomic deprivation were less likely to be treated. In 2005, in addition to treatment with guideline-recommended beta-blockers, a further 11.7% of men and 12.5% of women were prescribed other beta-blockers. CONCLUSION: Recommended beta-blocker use has risen in the UK but remains low and inequitable, with many patients still treated with beta-blockers that are not recommended in guidelines. This suggests further improvements in prescribing are still possible.
BACKGROUND: Treatment with specific beta-blockers reduces mortality and hospitalisation in heart failure. AIM: To describe trends and inequities in beta-blocker prescribing for heart failure. DESIGN OF STUDY: Repeated cross-sectional analysis of a nationally representative primary care database (DIN-LINK). SETTING: A total of 152 UK general practices. METHOD: Prescribing of beta-blockers between 2000 and 2005 was examined among a yearly average of 7294 patients aged>or=50 years who had actively managed heart failure - defined as a recorded diagnosis of heart failure and two prescriptions of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker during the calendar year. The main outcome was the prescription of a guideline-recommended beta-blocker (bisoprolol, carvedilol, metoprolol, or nebivolol) in the year. Determinants of beta-blocker prescribing were analysed using logistic regression. RESULTS: Between 2000 and 2005, age-adjusted use of recommended beta-blockers rose from 6.1% to 27.0% in men, and from 4.2% to 21.5% in women. In 2005, younger patients were more likely to be treated; the fully adjusted odds ratio was 4.83 (95% confidence interval=3.78 to 6.17) for patients aged 60-64 years compared with those aged 85 years. Women and patients living in areas of socioeconomic deprivation were less likely to be treated. In 2005, in addition to treatment with guideline-recommended beta-blockers, a further 11.7% of men and 12.5% of women were prescribed other beta-blockers. CONCLUSION: Recommended beta-blocker use has risen in the UK but remains low and inequitable, with many patients still treated with beta-blockers that are not recommended in guidelines. This suggests further improvements in prescribing are still possible.
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Authors: Behnood Bikdeli; Brian Wayda; Haikun Bao; Joseph S Ross; Xiao Xu; Sarwat I Chaudhry; John A Spertus; Susannah M Bernheim; Peter K Lindenauer; Harlan M Krumholz Journal: Circ Cardiovasc Qual Outcomes Date: 2014-07-29
Authors: Dipak Kotecha; Luis Manzano; Henry Krum; Giuseppe Rosano; Jane Holmes; Douglas G Altman; Peter D Collins; Milton Packer; John Wikstrand; Andrew J S Coats; John G F Cleland; Paulus Kirchhof; Thomas G von Lueder; Alan S Rigby; Bert Andersson; Gregory Y H Lip; Dirk J van Veldhuisen; Marcelo C Shibata; Hans Wedel; Michael Böhm; Marcus D Flather Journal: BMJ Date: 2016-04-20