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[Current use of beta-blockers in coronary artery disease]
L Gullestad1, R Bjørnerheim, J Offstad
1Medisinsk avdeling B Rikshospitalet, Oslo.
Insights
Beta-blocker use in coronary artery disease patients varied significantly, with underdosing observed in critical care and chronic conditions. This highlights potential gaps in guideline adherence for cardiovascular disease management.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Context:
- Retrospective analysis of beta-blocker utilization in Norwegian hospitals (1990-1997).
- Comparison between inpatient admissions for chest pain and stable coronary artery disease cohorts (4S study).
- Focus on treatment patterns in high-risk groups including diabetics and patients with peripheral artery disease.
Purpose:
- To evaluate the real-world use and dosing of beta-blockers in patients with coronary artery disease.
- To identify disparities in beta-blocker prescription rates across different patient subgroups and clinical settings.
- To assess adherence to recommended beta-blocker dosing strategies for improved cardiovascular outcomes.
Summary:
- Beta-blocker use ranged from 70-78% in hospitalized patients with chest pain to 43-60% in stable coronary artery disease patients.
- High-risk patients, including diabetics and those with peripheral artery disease, showed less differential treatment over time.
- Low rates of beta-blocker administration were noted in congestive heart failure (15% oral) and acute myocardial infarction (10.5% IV), with suboptimal dosing (approx. 50% of target survival doses).
Impact:
- Reveals suboptimal beta-blocker prescribing and dosing in routine clinical practice for coronary artery disease.
- Suggests a need for improved guideline implementation and physician education to optimize cardiovascular care.
- Underscores the potential for enhanced patient outcomes through more consistent and appropriate beta-blocker therapy.
Abstract:
This article presents the results of a retrospective analysis of the use of beta-blockers and current dosing of these agents in patients with coronary artery disease. While 70 to 78% of patients admitted to Norwegian university hospitals during 1990-1997 for angiographic evaluation of chest pain used beta-blockers, only 43-60% of patients with stable coronary artery disease enrolled in the 4S study in Norway received such treatment. High risk groups such as diabetics and patients with peripheral artery disease were less likely to receive beta-blockers during the early period, but were not treated differentially compared to low risk patients during recent years. Only 15% of patients with congestive heart failure received oral beta-blockers, and only 10.5% intravenous beta-blockade during acute myocardial infarction. The dosing of the most common beta-blockers were low, approximately 50% of doses shown to improve survival after acute myocardial infarction.