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Research Letter |

Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart Failure

Kumar Dharmarajan, MD, MBA1,4; Frederick A. Masoudi, MD, MSPH2; John A. Spertus, MD, MPH3; Shu-Xia Li, PhD4; Harlan M. Krumholz, MD, SM4,5,6
[+] Author Affiliations
1Division of Cardiology, Columbia University Medical Center, New York, New York
2Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
3St Luke’s Mid America Heart Institute/University of Missouri, Kansas City
4Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
5Section of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut
6Robert Wood Johnson Clinical Scholars Program and Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2013;173(16):1547-1549. doi:10.1001/jamainternmed.2013.7717.
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Extract

To increase β-blocker treatment for patients with heart failure and left ventricular systolic dysfunction, recently updated performance measures recommend that oral β-blocker therapy be started by the time of hospital discharge in patients hospitalized for decompensated systolic heart failure.1 These performance measures make clear that patients in whom a β-blocker therapy is started
should not be hospitalized in an intensive care unit [ICU], should have no or minimal evidence of fluid overload or volume depletion, and should not have required recent treatment with an intravenous positive inotropic agent.1(p2393)
To assess current patterns of β-blocker therapy initiation in these patients at risk for worsening clinical instability from β-blocker use, we examined a large, contemporary cohort of heart failure hospitalizations in the United States.

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Figure.
Potential Contraindications to Therapy

Proportion of patients hospitalized for heart failure receiving a new β-blocker prescription at discharge despite potential contraindications to therapy. AMI indicates acute myocardial infarction; ICU, intensive care unit; and IV, intravenous.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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