Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3036 — Quality of VA Heart Failure Care: Beta-Blockers Use

Heidenreich PA (Palo Alto VA) , Sahay A (Palo Alto VA), Massie B (San Francisco VA)

Objectives:
Beta-blockers are known to prolong survival for heart failure (HF) patients with reduced left ventricular ejection fraction (EF). Guidelines recommend using beta-blockers shown to prolong survival in randomized trials (carvedilol, metoprolol succinate, and bisoprolol). We sought to examine one aspect of quality of VA HF care by determining the use of beta-blockers in appropriate HF patients.

Methods:
We used data from the External Peer Review Program (EPRP) that contains chart review data from VA patients hospitalized with HF from first quarter 2004 to third quarter 2005. For those with a confirmed HF diagnosis prior to admission, the use of beta-blockers, type of beta-blocker, contraindications to beta-blockers (defined as any provider documentation), and left ventricular ejection fraction (<40% or >=40%) were recorded. Candidates for beta-blockers were HF patients with an EF < 40% and no contraindication.

Results:
There were 10,504 patients with an outpatient diagnosis of heart failure. Of these 5,966 (56%) had an EF below 40% and, of these 5,497 had no contraindication to beta-blockers. Of the 5,497 candidates for beta-blockers, 4,646 (85%) were treated with a beta-blocker and 2,565 (47%) were treated with a recommended beta-blocker. From the first quarter of 2004 to the 3rd quarter of 2005, beta-blocker use increased from 82% to 87%, p for trend <0.001. Younger age was associated with more beta-blocker use (mean age in years 69.6 for beta-blocker, 70.9 for no beta-blocker, p=0.0006). Hospital characteristics associated with more beta-blocker use included membership in the Council on Teaching Hospitals (COTH) (85 vs. 81%, p<0.0001). In multivariate analysis increasing age remained associated with less use (odds ratio 0.90 per 10 year increase 95% CI 0.83-0.97) while COTH membership was associated with more use (odds ratio 1.30, 95% CI 1.09-1.63).

Implications:
Use of Beta-blockers within the VA system has reached 85% in appropriate patients, and has improved significantly during the last few years. However only 50% were treated with the beta-blockers recommended by clinical guidelines.

Impacts:
Additional interventions are needed to increase the use of guideline recommended beta-blockers.