Beta blockers ‘underused’ before and after device implantation in HF patients

5 March 2010

MedWire News: Beta blockers are underused before and after cardiac device procedures in patients with heart failure (HF), a US study shows.

Researchers report that beta blockers are underused in the 90 days before such a procedure, and remain so despite a modest increase in use after the procedure.

Thus, underuse of evidence-based medication in HF management “now extends to the growing population of patients undergoing an implantation or a revision of an ICD [implantable cardioverter defibrillator] or CRT [cardiac resynchronization therapy],” report Paul Hauptman (Saint Louis University Hospital, Missouri) and colleagues.

Current guidelines emphasize the need for optimal medical therapy before implantation of cardiac devices, with beta blockers in particular thought to decrease the incidence of sudden cardiac death and improve left ventricular ejection fraction.

To evaluate beta-blocker use in practice, the researchers studied data from a large, multistate, managed-care database for the years 2003 through 2006, identifying a total of 2766 patients (median age 61 years) who underwent a device procedure for primary prevention.

Among these patients, the median number of prescription-covered days in the 90 days leading up to hospitalization for the procedure was 46. The percentage of patients using beta blockers steadily increased during this time, peaking at 54.5%, while the percentage without at least 1 day of prescribed beta-blocker therapy at any time point during this period was 33.4%.

A shift towards greater use of beta-blocker therapy was observed after the device procedure. Overall, 83.4% of patients had at least one pharmacy fill for a beta blocker during the 180-day follow-up and the median number of days on therapy was 155. Of 925 patients with no prior use, 55.9% had at least one fill in the 180 days after the procedure, and 571 (65.9%) shifted to at least low use (up to 40% of days covered).

In contrast, there was a “very modest degree of decay in use among patients with the highest level of use before the procedure,” note Hauptman et al.

“Underutilization of beta blockers is significant among patients undergoing implantation or revision of an implantable cardiac rhythm device,” the authors write in the journal Circulation: Cardiovascular Quality and Outcomes.

They conclude: “Because beta blockers can affect risk of sudden death and overall outcomes, further study is required to delineate the extent of the problem in the non-managed-care setting, to link underuse with poorer outcomes, and to devise strategies to ensure that optimal medical therapy is provided to patients before device implantation.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Circ Cardiovasc Qual Outcomes 2010; 3: 204–211