Rates Of Beta-blocker Use Research Articles

EFFECT OF SYSTEMIC BETA-BLOCKERS, ACE INHIBITORS, AND ANGIOTENSIN RECEPTOR BLOCKERS ON DEVELOPMENT OF CHOROIDAL NEOVASCULARIZATION IN PATIENTS WITH AGE-RELATED MACULAR DEGENERATION.

Recent studies have suggested that the use of systemic beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers can induce regression of choroidal neovascularization in rodent models. The purpose of this study is to evaluate if these agents have a protective effect against the development of choroidal neovascularization in patients with age-related macular degeneration. In this single-center retrospective case-control study, the charts of 250 patients with neovascular age-related macular degeneration were compared with those of 250 controls with dry age-related macular degeneration. Charts were reviewed for current and past use of beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers. Frequency tables were generated, and associations were examined using chi-square tests, t-tests, and multivariate logistic regression. There was no statistically significant difference between rates of beta-blocker use (P = 0.57), angiotensin-converting enzyme inhibitors use (P = 0.20), or angiotensin receptor blockers use (P = 0.61) between the 2 groups. Additionally, there was no statistically significant difference between rates of use of combinations of the above drugs between the two groups. Although there is growing evidence that beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers can induce regression of choroidal neovascularization in rodent models, these medications do not seem to confer a protective effect against the development of choroidal neovascularization in patients with age-related macular degeneration.

Heart rate and the use of beta-blockers in stable outpatients with coronary artery disease: Polish baseline results of the CLARIFY registry.

Heart rate (HR) is an important risk factor in coronary artery disease (CAD). However, there is little contemporary data on HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice. To describe HR in the Polish population of the CLARIFY registry, overall and in relation to beta-blocker use, and to assess the determinants of HR. CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as either prior myocardial infarction or revascularisation procedure, or evidence of coronary stenosis of at least 50%, or chest pain associated with proven myocardial ischaemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, the Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. In Poland, 1,004 patients were enrolled between February and June 2010, which was the largest population among countries from Eastern Europe. Most patients were men (72.8%). Mean ± standard deviation age was 62.1 ± 9.1 years. HR determined by pulse was 69.3 ± 9.4 bpm and by electrocardiogram was 68.2 ± 10.6 bpm. Beta-blockers were used in 89.9% of patients. Resting HR ≥ 70 bpm was noted in 49.3% of all patients and in 48.6% of patients on beta-blockers. Resting HR ≥ 70 bpm was significantly more frequent among younger patients, and in those with diabetes, those being treated for arterial hypertension, and who lacked regular physical activity. Patients with HR ≥ 70 bpm at rest had more frequent symptoms of angina and more frequently needed hospitalisation due to heart failure. Despite a very high rate of beta-blocker use, almost 50% of patients with stable CAD had a resting HR ≥ 70 bpm, which was associated with more frequent angina and ischaemia. Further HR lowering is possible in many patients with CAD. Whether or not this will improve symptoms and outcomes is under investigation.

HEDIS antidepressant medication management measures and performance-based measures: an opportunity for improvement in depression care.

Using the Health Plan Employer Data and Information Set (HEDIS), the National Committee for Quality Assurance partners with more than 90% of the nation's managed care organizations to collect, audit, and report performance on a range of standardized healthcare quality measures. Many HEDIS measures have been useful in promoting population health, such as rate of beta-blocker use after myocardial infarction or rate of cervical cancer screening. Other measures, such as those for Antidepressant Medication Management (AMM), have been less successful. Several trends are occurring within behavioral health management that attempt to improve depression treatment outcomes, including the implementation of performance-based initiatives using the HEDIS AMM measures and the 9-item Patient Health Questionnaire. Ultimately, linking quality measures to clinical strategies is critical for achieving successful depression treatment outcomes.

Prophylaxis with beta blockers as a performance measure of quality health care in cirrhosis

Prophylaxis with beta blockers as a performance measure of quality health care in cirrhosis

Changes in rates of beta-blocker use in community hospital patients with acute myocardial infarction.

To examine changes in the rate of beta-blocker (BB) use at admission, in hospital, and at discharge between 1994 and 1995 (MICH I) and 1997 (MICH II) in patients with acute myocardial infarction (AMI). Comparison of two prospectively enrolled cohorts. Five mid-Michigan community hospitals. We studied 287 MICH I patients and 121 MICH II patients with AMI who had no contraindications to BB use from cohorts of consecutively admitted cases of AMI (814 in MICH I; 500 in MICH II). Prescription of BBs to ideal patients with AMI increased in patients with previous history of myocardial infarction on arrival at the hospital (12.5% vs 36.0%; P= .01), in hospital (47.0% vs 76%; P < .01), and at discharge (34.0% vs 61.9%; P < .01). Neither race nor gender was a predictor of BB use. Younger age predicted BB prescription at discharge (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.32 to 3.23). Later study cohort was the most important predictor of BB use in hospital (OR, 3.4; 95% CI, 2.09 to 5.25). BB use improved dramatically over the study period, but additional work is needed to improve use of BB after discharge and among elderly patients with AMI.

Hospital-Level Performance Improvement

National surveys indicate improvement in beta-blocker use after acute myocardial infarction (AMI) over time; however, these data could obscure important variation in improvement at individual hospitals. Our objective was to characterize the hospital-level variation in the improvements in beta-blocker prescription rates after AMI and to identify hospital characteristics that were associated with hospital improvement rates after adjustment for patient demographic and clinical characteristics. We used data (n = 335,244 patients with AMI discharged from 682 hospitals) from the National Registry of Myocardial Infarction (NRMI) and from the American Hospital Association Annual Survey of Hospitals and hierarchical modeling to examine the associations between hospital characteristics and hospital-level rates of change in beta-blocker use during 1996-1999. On average, hospital rates of beta-blocker use for patients with AMI increased 5.9 percentage points (standard deviation, 9.7 percentage points) from the premidpoint time period (April 1996-February 1998) to the postmidpoint time period (March 1998-September 1999) of the study. The range in hospital-level changes in beta-blocker rates was substantial, from a decline of -50.0 percentage points to an increase of +35.7 percentage points. AMI volume and teaching status, geographic region, and initial beta-blocker use rates were associated with rate of improvement, but the magnitude of these effects was modest. The study reveals marked hospital-level variation in improvement in beta-blocker use after AMI. Several hospital characteristics were associated with this improvement, but they are weak predictors of hospital-based improvement in the use of beta-blockers.