This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (49)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

National Patterns and Predictors of -Blocker Use in Patients With Coronary Artery Disease

Thomas J. Wang, MD; Randall S. Stafford, MD, PhD

Arch Intern Med. 1998;158:1901-1906.

Background  Prior studies suggest underuse of -blockers in patients with coronary artery disease, but these studies have been based on selected populations of recently hospitalized patients.

Objective  To describe national patterns and determinants of -blocker use in the ambulatory setting.

Methods  We analyzed 11745 visits by patients with coronary artery disease to randomly selected, office-based physicians in the National Ambulatory Medical Care Surveys for 1980, 1981, 1985, and 1989 through 1996. We used multiple logistic regression to determine the independent effect of sociodemographic and clinical factors on -blocker use.

Outcome Measure  -Blocker use at patient visits.

Results  -Blocker use was reported in only 20.9% of office visits by patients with coronary artery disease and no strong contraindications between 1993 and 1996. In multivariate analyses, age younger than 75 years, residence in the Northeast, and visits to cardiologists and internists compared with family and general practitioners predicted greater use of -blocker therapy. White race and private insurance also were significant predictors of -blocker use between 1980 and 1996. Longitudinal analyses revealed a significant decline in -blocker use from 1980 to 1990, followed by a gradual increase in recent years.

Conclusions  -Blockers appear to be underused in ambulatory patients with coronary artery disease. Our data suggest that nonclinical factors may influence rates of use, indicating the need for closer scrutiny of variations in physician prescribing practices.

From the Institute for Health Policy, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston, Mass.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Long term medical treatment of stable coronary disease
Shavelle
Heart 2007;93:1473-1477.
FULL TEXT  

Long-Term and Short-Term Changes in Antihypertensive Prescribing by Office-Based Physicians in the United States
Stafford et al.
Hypertension 2006;48:213-218.
ABSTRACT | FULL TEXT  

Under-use of beta-blockers in patients with ischaemic heart disease and concomitant chronic obstructive pulmonary disease
Egred et al.
QJM 2005;98:493-497.
ABSTRACT | FULL TEXT  

The Impact of Private and Public Health Insurance on Medication Use for Adults with Chronic Diseases
Rice et al.
Med Care Res Rev 2005;62:231-249.
ABSTRACT  

A Multimethod Quality Improvement Intervention To Improve Preventive Cardiovascular Care: A Cluster Randomized Trial
Ornstein et al.
ANN INTERN MED 2004;141:523-532.
ABSTRACT | FULL TEXT  

Primary Care Management of Chronic Stable Angina and Asymptomatic Suspected or Known Coronary Artery Disease: A Clinical Practice Guideline from the American College of Physicians
Snow et al.
ANN INTERN MED 2004;141:562-567.
ABSTRACT | FULL TEXT  

Expert consensus document on {beta}-adrenergic receptor blockers: The Task Force on Beta-Blockers of the European Society of Cardiology
Task Force Members et al.
Eur Heart J 2004;25:1341-1362.
FULL TEXT  

Prognostic Value of Pharmacological Stress Echocardiography Is Affected by Concomitant Antiischemic Therapy at the Time of Testing
Sicari et al.
Circulation 2004;109:2428-2431.
ABSTRACT | FULL TEXT  

Update in Hospital Medicine
Auerbach and Kleinbart
ANN INTERN MED 2004;140:363-369.
FULL TEXT  

Inappropriate Medication Prescribing for Elderly Ambulatory Care Patients
Goulding
Arch Intern Med 2004;164:305-312.
ABSTRACT | FULL TEXT  

Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England
Ward et al.
J. Epidemiol. Community Health 2004;58:89-96.
ABSTRACT | FULL TEXT  

A Dose of Our Own Medicine: Alternative Medicine, Conventional Medicine, and the Standards of Science
Morreim
J Law Med Ethics 2003;31:222-235.
 

Risk Factors and Secondary Prevention in Women with Heart Disease: The Heart and Estrogen/progestin Replacement Study
Vittinghoff et al.
ANN INTERN MED 2003;138:81-89.
ABSTRACT | FULL TEXT  

The underutilization of cardiacmedications of proven benefit, 1990 to 2002
Stafford and Radley
J Am Coll Cardiol 2003;41:56-61.
ABSTRACT | FULL TEXT  

Cardioselective {beta}-Blockers in Patients with Reactive Airway Disease: A Meta-Analysis
Salpeter et al.
ANN INTERN MED 2002;137:715-725.
ABSTRACT | FULL TEXT  

Effect of beta blockers after coronary artery bypass in postinfarct patients: what can we learn from available literature?
Geraci and Haan
Ann. Thorac. Surg. 2002;74:1727-1732.
ABSTRACT | FULL TEXT  

Preoperative {beta}-Blocker Use and Mortality and Morbidity Following CABG Surgery in North America
Ferguson et al.
JAMA 2002;287:2221-2227.
ABSTRACT | FULL TEXT  

{beta}-Blockers and Reduction of Cardiac Events in Noncardiac Surgery: Scientific Review
Auerbach and Goldman
JAMA 2002;287:1435-1444.
ABSTRACT | FULL TEXT  

Supplemental Insurance and Use of Effective Cardiovascular Drugs Among Elderly Medicare Beneficiaries With Coronary Heart Disease
Federman et al.
JAMA 2001;286:1732-1739.
ABSTRACT | FULL TEXT  

Impact of reference-based pricing of nitrates on the use and costs of anti-anginal drugs
Grootendorst et al.
CMAJ 2001;165:1011-1019.
ABSTRACT | FULL TEXT  

Health and Economic Benefits of Increased {beta}-Blocker Use Following Myocardial Infarction
Phillips et al.
JAMA 2000;284:2748-2754.
ABSTRACT | FULL TEXT  

ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina)
Gibbons et al.
J Am Coll Cardiol 1999;33:2092-2197.
FULL TEXT  

Meta-analysis of Trials Comparing {beta}-Blockers, Calcium Antagonists, and Nitrates for Stable Angina
Heidenreich et al.
JAMA 1999;281:1927-1936.
ABSTRACT | FULL TEXT  

Problems With Measuring the Use of {beta}-Blockers in Ambulatory Settings for Secondary Prevention in Patients With Coronary Artery Disease
Kakaiya et al.
Arch Intern Med 1999;159:755-756.
FULL TEXT