Journal of Cardiac Failure
Volume 13, Issue 9 , Pages 722-731, November 2007

Prospective Evaluation of Beta-Blocker Use at the Time of Hospital Discharge as a Heart Failure Performance Measure: Results From OPTIMIZE-HF

  • Gregg C. Fonarow, MD

      Affiliations

    • Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, California
    • Corresponding Author InformationReprint requests: Gregg C. Fonarow, MD, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, CA 90095-1679.
    • ,
  • William T. Abraham, MD, FACP, FACC,

      Affiliations

    • Division of Cardiology, The Ohio State University, Columbus, Ohio
    • ,
  • Nancy M. Albert, PhD, RN

      Affiliations

    • George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio
    • ,
  • Wendy Gattis Stough, PHARMD

      Affiliations

    • Department of Medicine, Duke University Medical Center, Durham, North Carolina, and Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, North Carolina
    • ,
  • Mihai Gheorghiade, MD

      Affiliations

    • Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
    • ,
  • Barry H. Greenberg, MD

      Affiliations

    • Department of Medicine, UCSD Medical Center, University of California, San Diego, California
    • ,
  • Christopher M. O'Connor, MD

      Affiliations

    • Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina
    • ,
  • Jie Lena Sun, MS

      Affiliations

    • Duke Clinical Research Institute, Durham, North Carolina
    • ,
  • Clyde W. Yancy, MD

      Affiliations

    • Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas [current affiliation])
    • ,
  • James B. Young, MD

      Affiliations

    • Department of Cardiovascular Medicine, Heart Failure Section, Cleveland Clinic Foundation, Cleveland, Ohio
    • ,
  • on behalf of the OPTIMIZE-HF Investigators and Coordinators

Received 22 January 2007; received in revised form 17 May 2007; accepted 20 June 2007.

Abstract 

Background

The objective of this study was to prospectively evaluate beta-blocker use at hospital discharge as an indicator of quality of care and outcomes in patients with heart failure (HF).

Methods and Results

Data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry for patients hospitalized with HF from 259 hospitals were prospectively collected and analyzed. HF medication contraindications, intolerance, and use at hospital discharge were assessed, along with 60- to 90-day follow-up data in a prespecified cohort. There were 20,118 patients with left ventricular systolic dysfunction. At discharge, 90.6% of patients were eligible to receive beta-blockers, and 83.7% were eligible to receive an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Eligible patients discharged with beta-blockers were significantly more likely to be treated at follow-up than those not discharged with beta-blockers (93.1% vs 30.5%; P < .0001). Discharge use of beta-blockers in eligible patients was associated with a significant reduction in the adjusted risk of death (hazard ratio: 0.48; 95% confidence interval: 0.32–0.74; P < .001) and death/rehospitalization (odds ratio: 0.74; 95% confidence interval: 0.55–0.99; P = .04), although we cannot completely exclude the possibility of residual confounding.

Conclusions

Discharge beta-blocker use in HF appeared to be well tolerated, improved treatment rates, and was associated with substantially lower postdischarge mortality risk. These data provide additional evidence that supports beta-blocker use at hospital discharge in eligible patients as an HF performance measure.

Key Words: Beta-blockers, heart failure, performance measures, quality improvement

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 The OPTIMIZE-HF registry is registered: www.clinicaltrials.gov, study number NCT00344513. The OPTIMIZE-HF registry and this study were funded by GlaxoSmithKline, Philadelphia, Pennsylvania.

PII: S1071-9164(07)00942-6

doi:10.1016/j.cardfail.2007.06.727

Journal of Cardiac Failure
Volume 13, Issue 9 , Pages 722-731, November 2007

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