Low utilization of beta blockers among Medicare beneficiaries hospitalized for heart failure with reduced ejection fraction.
J Card Fail. 2018 Oct 16;:
Authors: Loop MS, Van Dyke MK, Chen L, Safford MM, Kilgore ML, Brown TM, Durant RW, Levitan EB
BACKGROUND: The evidence-based beta blockers carvedilol, bisoprolol, and metoprolol succinate reduce mortality and hospitalizations among patients with heart failure with reduced ejection fraction (HFrEF). Use of these medications is not well-described in the general population of patients with HFrEF, especially among patients with potential contraindications.
OBJECTIVES: Our goal was to describe the patterns of prescription fills for carvedilol, bisoprolol, and metoprolol succinate among Medicare beneficiaries hospitalized for HFrEF, as well as estimate the associations between specific contraindications for beta blocker therapy and these patterns.
METHODS: Using a cohort of 15,205 Medicare beneficiaries hospitalized for HFrEF between 2007 and 2013 from the 5% Medicare random sample, we described prescription fills (30-days post discharge) and dosage patterns (1-year post discharge) for beta blockers. Using Fine and Gray competing risk models, we estimated the associations between potential contraindications (hypotension, chronic obstructive pulmonary disease (COPD), asthma, and syncope) and prescription fill and dosing patterns while adjusting for demographics, comorbidities, and healthcare utilization.
RESULTS: For beneficiaries who did not die or were not readmitted to the hospital, 38% of hospitalizations were followed by a prescription fill for an evidence-based beta blocker within 30 days, 12% were followed by prescription fills for at least 50% of the recommended dose of an evidence-based beta blocker within 1 year, and 9% were followed by a prescription fill for an uptitrated dose of an evidence-based beta blocker within 1 year. The prevalence of the contraindications were 21% for hypotension, 48% for COPD, 15% for asthma, and 12% for syncope. Among beneficiaries who did not fill a prescription for an evidence-based beta blocker within 30 days, 67% had at least one of these contraindications. Hypotension, COPD, and syncope were each associated with an approximately 10% lower risk of filling a prescription for an evidence-based beta blocker.
CONCLUSIONS: Prescription fill and uptitration rates for evidence-based beta blockers are low among Medicare beneficiaries with HFrEF, but contraindications explain only a minor portion of these low rates.
PMID: 30339796 [PubMed - as supplied by publisher]