2028. Prescribing of Beta-blockers in VA Patients with Chronic Heart Failure
James A Rothendler, MD, CHQOER, Bedford VAMC, JI Reisman, CHQOER, Bedford VAMC, LE Kazis, CHQOER, Bedford VAMC, DR Berlowitz, CHQOER, Bedford VAMC, BG Graeme, CHQOER, Bedford VAMC, SA Gaehde, CHQOER, Bedford VAMC, ME Glickman, CHQOER, Bedford VAMC

Objectives: Guidelines regarding use of beta-adrenergic blockers (BB) in patients with chronic heart failure (CHF) have evolved in recent years with broadening of indications. We examined trends over 2.5 years in prescribing of BB in VA patients with CHF.

Methods: Study patients from four VA stations met the following criteria: Two or more visits during 7/98-6/99 to primary care, general medicine, women’s health or cardiology clinics, last recorded left ventricular ejection fraction <40% as of 6/30/99 (or qualitatively at least moderately reduced left ventricular function), and at least one prescription file-related dispense during 7/99-12/99 and 7/02-12/02 of certain other CHF medications (angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, digoxin, or diuretics). Prescriptions for BB were assessed during 6-month intervals from 7/99-6/02.

Results: Of 323 patients meeting inclusion criteria, there was a significant increase from the period 7/99-12/99 to 1/02-6/02 in the percentage with at least one prescription file-related dispense of BB (63.5% to 76.2%, p<.05 for trend). This percentage was lower for those >75 years old compared to younger patients at initial and ending time periods (52.1% vs. 68.3%, 7/99-12/99 and 69.8% vs. 81.0%, 1/02-6/02, p<.05).

Conclusions: In study patients with CHF who continued to receive certain CHF medications over a 2.5-year period, dispensing of BB increased significantly; however, elderly patients remained less likely to receive such therapy.

Impact: These findings suggest that there has been increasing utilization of BB in VA patients with CHF. Further work is needed to assess apparent age-related differences in BB prescribing.