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National patterns and predictors of beta-blocker use in patients with coronary artery disease
1Institute for Health Policy, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston 02114, USA.
Insights
Beta-blocker use is low in ambulatory patients with coronary artery disease. Non-clinical factors, like insurance and physician specialty, significantly impact beta-blocker prescriptions, suggesting a need to examine prescribing patterns.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Prior studies indicate potential underuse of beta-blockers in coronary artery disease (CAD) patients.
- Existing research often focuses on selected, recently hospitalized populations, limiting generalizability.
Purpose of the Study:
- To investigate national patterns of beta-blocker utilization among ambulatory patients with CAD.
- To identify sociodemographic and clinical determinants influencing beta-blocker prescription in this population.
Main Methods:
- Analysis of 11,745 office visits for patients with CAD from the National Ambulatory Medical Care Surveys (1980-1996).
- Multivariate logistic regression used to assess factors associated with beta-blocker use.
- Longitudinal analysis to track trends in beta-blocker utilization over time.
Main Results:
- Beta-blocker use was documented in only 20.9% of CAD patient visits (1993-1996) without contraindications.
- Younger age (<75), Northeast residence, and specialist visits (cardiologists, internists) predicted higher use.
- White race and private insurance were also significant predictors of beta-blocker use (1980-1996).
- A decline in use was observed from 1980-1990, followed by a slight increase.
Conclusions:
- Beta-blockers are likely underused in the ambulatory CAD patient population.
- Non-clinical factors appear to influence beta-blocker prescribing rates.
- Further investigation into physician prescribing practices is warranted to address observed variations.
Background:
Prior studies suggest underuse of beta-blockers in patients with coronary artery disease, but these studies have been based on selected populations of recently hospitalized patients.
Objective:
To describe national patterns and determinants of beta-blocker use in the ambulatory setting.
Methods:
We analyzed 11745 visits by patients with coronary artery disease to randomly selected, office-based physicians in the National Ambulatory Medical Care Surveys for 1980, 1981, 1985, and 1989 through 1996. We used multiple logistic regression to determine the independent effect of sociodemographic and clinical factors on beta-blocker use.
Outcome Measure:
Beta-blocker use at patient visits.
Results:
Beta-blocker use was reported in only 20.9% of office visits by patients with coronary artery disease and no strong contraindications between 1993 and 1996. In multivariate analyses, age younger than 75 years, residence in the Northeast, and visits to cardiologists and internists compared with family and general practitioners predicted greater use of beta-blocker therapy. White race and private insurance also were significant predictors of beta-blocker use between 1980 and 1996. Longitudinal analyses revealed a significant decline in beta-blocker use from 1980 to 1990, followed by a gradual increase in recent years.
Conclusions:
Beta-blockers appear to be underused in ambulatory patients with coronary artery disease. Our data suggest that nonclinical factors may influence rates of use, indicating the need for closer scrutiny of variations in physician prescribing practices.