Translation of clinical trial results into practice: Temporal patterns of β-blocker utilization for heart failure at hospital discharge and during ambulatory follow-up

Background: Underutilization of β-blockers in heart failure (HF) has been widely reported at hospital discharge and in the ambulatory setting. We examined recent temporal patterns of β-blocker utilization in HF with systolic dysfunction at hospital discharge and over 2-year follow-up. Methods: Annual trends of β-blocker use were examined in a clinical database of patients with ejection fraction ≤40% discharged after HF hospitalization in 1998-2004 (n = 735). More detailed data on β-blocker use at discharge and over 2-year follow-up were abstracted for 200 consecutive patients each in 1999-2001 and 2003-2004. Results: Annual rates of β-blocker use at discharge increased steadily by 10% per year from 1998-2004 (P < .001), with no sharp increase noted in any single year after publication of clinical trials or guidelines. Use among patients without contraindications increased markedly from 1999-2001 to 2003-2004 at hospital discharge (38.7% vs 82.6%, P < .001) and 2-year follow-up (53.0% vs 84.5%, P < .001). The increase was significant in all examined subgroups. Although >50% of patients remained on low doses of β-blockers, a greater proportion trended to reach target doses at 2 years in the later period (25.6% vs 12.5%, P = .13). Conclusions: Substantial increase in β-blocker utilization in HF with systolic dysfunction occurred from 1998 to 2004, demonstrating that high rates of β-blocker use are being achieved at hospital discharge and maintained in the ambulatory setting after discharge. However, the time lag in translation of scientific evidence into maximal use of beneficial therapy in practice remains a target for quality improvement.