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Underutilization of beta-blockers in patients undergoing implantable cardioverter-defibrillator and cardiac

Paul J Hauptman1, Jason P Swindle, Frederick A Masoudi

  • 1Department of Medicine, Division of Cardiology, Saint Louis University School of Medicine, St Louis, MO 63110, USA. hauptmpj@slu.edu

Circulation. Cardiovascular Quality and Outcomes
|March 4, 2010
PubMed

Insights

Beta-blockers (BB) are underused in heart failure patients before and after cardiac device implantation, despite guidelines recommending optimal medical therapy. Post-procedure BB use shows a modest increase, highlighting a need for improved pre-procedure management.

Area of Science:

  • Cardiology
  • Pharmacology
  • Health Services Research

Background:

  • Current guidelines advocate for optimal medical therapy prior to cardiac device implantation.
  • Evaluation of beta-blocker (BB) utilization in heart failure patients undergoing cardiac device procedures is essential.

Purpose of the Study:

  • To assess the utilization of beta-blockers (BB) in patients with heart failure before and after cardiac device implantation.
  • To identify trends in BB use in relation to cardiac device procedures.

Main Methods:

  • Analysis of a large, multistate managed-care database (2003-2006).
  • Inclusion criteria: adults with heart failure diagnosis and cardiac device procedure, with 180-day pre- and post-procedure enrollment.
  • Primary outcome measures: BB use before device procedure and changes in use after discharge.

Main Results:

  • A total of 2766 patients (78.8% male, median age 61) underwent primary prevention device procedures.
  • 33.4% of patients did not have a pharmacy fill for BB in the 90 days preceding the procedure; these patients were older with fewer cardiology visits.
  • BB use increased post-procedure, with 83.4% having at least one pharmacy fill during follow-up.

Conclusions:

  • Beta-blockers (BB) are underutilized both before and after cardiac device procedures in heart failure patients.
  • A slight increase in BB use is observed after device implantation.
  • Strategies are needed to ensure optimal medical therapy, including BB, is initiated before device selection.
Abstract

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