β-Blocker dosing in community-based treatment of heart failure

Background Community patients with heart failure (HF) are older, less often treated by HF specialists, and have more comorbidity than those in randomized clinical trials. These differences might affect β-blocker prescribing in HF. Methods To explore patterns of β-blocker prescribing for HF in the community and their association with outcomes, we determined carvedilol doses at end titration in 4113 patients from a community-based β-blocker HF registry according to physician and patient characteristics, HF severity, and rates of hospitalization and death. Results Female sex, age ≥65 years, and left ventricular ejection fraction ≥35% were associated with lower β-blocker doses. Average daily dose of β-blocker was lower with worse baseline New York Heart Association class. More patients of cardiologists achieved carvedilol doses ≥25 mg twice daily, whereas in those of noncardiologists lower doses were more common. Relative risk of HF hospitalizations or all-cause death was significantly lower with higher doses of β-blocker. Conclusions β-Blocker dosing in community HF appears lower than in randomized clinical trials, especially when prescribed by noncardiologists. At all doses, patients taking the β-blocker carvedilol have a lower incidence of death and HF hospitalization than those discontinuing it, regardless of physician type in the community setting.