Abstract 18410: Prescriptions for and Use of β-Blocker Following Heart Failure Hospitalization: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Abstract

Introduction: In heart failure (HF) with reduced ejection fraction (HFrEF), there is evidence that the β-blockers metoprolol succinate, bisoprolol and carvedilol improve prognosis. Objective: To examine β-blocker prescriptions and fills after HF hospitalization. Methods: In 2006-2011, we identified 344 HF hospitalizations (147 HFrEF, 152 with preserved ejection fraction, 45 unknown) with linked Medicare claims among 201 participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a cohort of 30,239 black and white adults. Comorbidities and prescriptions were abstracted from medical records. Claims were used to assess prescription fills. Risk ratios (RR) and confidence intervals (CI) for β-blocker prescriptions and fills were calculated using generalized estimating equations adjusted for age, race and sex. Results: Women accounted for 59% of HF hospitalizations and blacks 54%; 90% had prior HF. β-blockers were prescribed for 78% (87% with HFrEF); 58% (74% with HFrEF) of β-blocker prescriptions were metoprolol succinate, bisoprolol or carvedilol. Prescriptions were filled within 30 days of discharge for 46%. There was evidence of β-blocker up-titration for 9% (21% with HFrEF). HFrEF was more strongly associated with prescriptions and fills of metoprolol succinate, bisoprolol or carvedilol (RR 1.82 [95% CI 1.32, 2.53] and 1.73 [95% CI 1.12, 2.68], respectively) than any β-blocker (RR 1.12 [95% CI 0.99, 1.27] and 1.06 [95% CI 0.82, 1.36], respectively). After HFrEF hospitalization, black race and β-blockers at admission were positively associated with β-blocker prescriptions, female sex was positively associated with fills and chronic obstructive pulmonary disease was inversely, but not significantly, associated with prescriptions and fills ( Table ). Conclusions: β-blockers were prescribed at discharge for most HF hospitalizations, but many prescriptions do not appear to have been filled and up-titration was rare.