Beta-blocker utilization in congestive heart failure: A survey on 4408 Italian outpatients over the last two years

Background: Several trials have shown that beta-blockers (βB) reduce morbidity and mortality of the pts with congestive heart failure (CHF). However, only a minority of pts who might benefit from this treatment are actually treated.Aims of the study were to evaluate in a large population of Italian outpatients: (a) the rate of use of βB over the last two years; (b) clinical determinants associated with their utilization.Methods: Data were collected by locally trained clinicians using an ad-hoc software. Univariate and multivariate analyses were performed to evaluate the association between clinical variables and βB prescription.Results: A total of 4408 pts entered the database. Overall, 498 (11.3%) pts were on treatment with βB at study entry. The rate of prescription increased from 9% to 15.7% (March 1995 to January 1997) (p < 0.001). The relationship between clinical-epidemiological variables and βB prescription is shown in the table. At unadjusted analysis, while EF% and the presence of ventricular tachycardia (VT) did not affect βB prescription, younger age, CHF due to DCM, NYHA class I-II vs III-IV were significantly associated with a higher rate of βB utilization.Multivariate analysis showed that younger age and DCM etiology were independently associated with more βB prescriptions (OR 2.11 95%Cl 1.65-2.71 and OR 1.35 95% Cl 1.09-1.69).Conclusions: The rate of βB prescriptions significantly increased over the last 2 year among outpatients with CHF. Among these pts, the subgroups at lower risk are more likely to be treated with βB.