Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2011;64:883-90 - Vol. 64 Num.10 DOI: 10.1016/j.rec.2011.05.027

How Beta-Blockers Are Used in Spain? Analysis of Limitations in Their Use in Internal Medicine and Cardiology: CARACTER-BETA Study

Xavier Garcia-Moll a,, Lorenzo Fácila b, Pedro Conthe c, Antonio Zapata d, Remei Artigas d, Vicente Bertomeu e, José Ramón González-Juanatey f

a Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
b Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
c Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d Laboratorios Menarini, Badalona, Barcelona, Spain
e Servicio de Cardiología, Hospital de San Juan, San Juan de Alicante, Alicante, Spain
f Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain

Keywords

Stable angina. Atrial fibrillation. Heart failure. Beta-blockers.

Abstract

Introduction and objectives

Beta-blocker treatment has a class I indication, level of evidence A, in guidelines for the treatment of heart failure, ischemic heart disease, and atrial fibrillation. However, beta-blocker use continues to be less than optimal. In this study, beta-blocker use in Spain is analyzed in patients with heart failure, ischemic heart disease, and atrial fibrillation.

Methods

Observational, epidemiologic, cross-sectional, multicenter study including 1608 patients with heart failure, ischemic heart disease, and/or atrial fibrillation, recruited in 150 healthcare centers by cardiologists and internal medicine specialists.

Results

Cardiologists enrolled 78.6% patients and internal medicine specialists 21.4%; 25.8% were recruited at hospital discharge and 74.2% at outpatient centers. Men accounted for 77% of the sample, and age was 68 (12) years. Of the total, 73% had ischemic heart disease, 42% heart failure, and 36% atrial fibrillation (multiresponse variable). beta-blockers were given to 82.8% of those consulting in cardiology compared to 71.6% of those treated in internal medicine (P<.0001). By pathology, the prescription rate was 85.1% of patients with ischemic heart disease, 77.0% of those with heart failure, and 72.4% of those with atrial fibrillation. Cardiology prescribed significantly more beta-blockers for ischemic heart disease and heart failure than did internal medicine. Multivariate analysis showed that beta-blocker use increased when the patient had ischemic heart disease, was treated by a cardiologist, and had dyslipidemia, stroke, and/or left ventricular hypertrophy. Beta-blocker use decreased with age and with a history of bronchospasm, asthma, bradycardia, chronic obstructive pulmonary disease, and/or intermittent claudication.

Conclusions

There is still room for improvement in beta-blocker prescription in Spain for patients with ischemic heart disease, heart failure, and/or atrial fibrillation.

1885-5857/© 2011 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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