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Comment & Response |

Caution Warranted When Defining Contraindications in Initiating β-Blocker Therapy—Reply

Kumar Dharmarajan, MD, MBA1,2; Harlan M. Krumholz, MD, SM2,3,4
[+] Author Affiliations
1Division of Cardiology, Columbia University Medical Center, New York, New York
2Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
3Section of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut
4Robert Wood Johnson Clinical Scholars Program, Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2014;174(3):481-482. doi:10.1001/jamainternmed.2013.13685.
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In Reply Dr Miyares raises several excellent points, correctly noting that our study sample may include persons receiving β-blocker therapy prior to admission who had treatment temporarily withheld early during hospitalization. Without access to outpatient pharmacy claims, we could not ascertain the proportion of our study sample in this category. However, even in the unlikely scenario that three-quarters of our sample had received β-blocker therapy prior to hospitalization, our findings still imply that many thousands of patients hospitalized for acute heart failure in the United States are initiated on β-blocker treatment despite potential contraindications. In addition, the receipt of β-blocker therapy prior to hospitalization does not imply that reinitiating treatment prior to discharge is necessarily safe. This finding has yet to be demonstrated and would require a large, prospective clinical trial to avoid confounding.


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March 1, 2014
Marta A. Miyares, PharmD, BCPS
1Department of Pharmacy, Jackson Memorial Hospital, Miami, Florida
JAMA Intern Med. 2014;174(3):481. doi:10.1001/jamainternmed.2013.13698.
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