PMID- 22840685
OWN - NLM
STAT- MEDLINE
DCOM- 20140422
LR  - 20161125
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 167
IP  - 6
DP  - 2013 Sep 10
TI  - Discontinuation of beta-blockers in cardiovascular disease: UK primary care 
      cohort study.
PG  - 2695-9
LID - S0167-5273(12)00907-2 [pii]
LID - 10.1016/j.ijcard.2012.06.116 [doi]
AB  - AIMS: The present study aims to investigate patterns of beta-blocker usage in a 
      national primary care cohort. METHODS AND RESULTS: This is a retrospective cohort 
      study utilising the UK General Practice Research Database from 2004 to 2008. 
      Inclusion criteria were (i) a first diagnosis of chronic heart failure (CHF), 
      myocardial infarction (MI) or angina, and (ii) first-ever prescription of 
      beta-blocker on or after 1st April 2004. Outcome measures were discontinuation of 
      beta-blockers over time, initiation dosages, titration patterns, incidence of 
      adverse events (AEs) and associated prescribing actions. A total of 12,493 
      patients (68.0% male; mean age 58.0 +/- SD 17.6 years) were included. Of these, 27% 
      had discontinued beta-blockers within 1 year of initiation, increasing to 39% by 
      2 years and 50% by 3 years. Persistence appeared to be greater in the MI cohort 
      compared with angina or CHF cohorts. Beta-blocker dose at initiation averaged 
      approximately 33% of guideline recommended target, rising to 40% in those who 
      continued with therapy. Dyspnoea, fatigue and dizziness were the most common 
      incident AEs at 98, 53 and 49 per 1000 patient years, with little difference 
      between indications. CONCLUSION: A quarter of patients with cardiovascular 
      disease who are commenced on a beta-blocker are no longer taking the drug by one 
      year. This rises to 50% by three years, a finding that is consistent irrespective 
      of whether the prescription is for prognostic (CHF or post MI) or symptomatic 
      (angina) benefit. There is an urgent need to understand and address the 
      prescribing difficulties of beta-blockers in these at-risk patients.
CI  - Copyright (c) 2012 Elsevier Ireland Ltd. All rights reserved.
FAU - Kalra, Paul R
AU  - Kalra PR
AD  - Department of Cardiology, Portsmouth Hospitals NHS Trust, Portsmouth, United 
      Kingdom. paul.kalra@porthosp.nhs.uk
FAU - Morley, Chris
AU  - Morley C
FAU - Barnes, Susie
AU  - Barnes S
FAU - Menown, Ian
AU  - Menown I
FAU - Kassianos, George
AU  - Kassianos G
FAU - Padmanabhan, Sandosh
AU  - Padmanabhan S
FAU - Gupta, Sandeep
AU  - Gupta S
FAU - Lang, Chim C
AU  - Lang CC
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120726
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Adrenergic beta-Antagonists)
SB  - IM
MH  - Adolescent
MH  - Adrenergic beta-Antagonists/*administration & dosage
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiovascular Diseases/*drug therapy/*epidemiology
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Primary Health Care/*methods
MH  - Retrospective Studies
MH  - United Kingdom/epidemiology
MH  - *Withholding Treatment
MH  - Young Adult
OTO - NOTNLM
OT  - Angina
OT  - Beta-blockers
OT  - Heart failure
OT  - Myocardial infarction
OT  - Persistence
EDAT- 2012/07/31 06:00
MHDA- 2014/04/23 06:00
CRDT- 2012/07/31 06:00
PHST- 2012/01/03 00:00 [received]
PHST- 2012/06/01 00:00 [revised]
PHST- 2012/06/24 00:00 [accepted]
PHST- 2012/07/31 06:00 [entrez]
PHST- 2012/07/31 06:00 [pubmed]
PHST- 2014/04/23 06:00 [medline]
AID - S0167-5273(12)00907-2 [pii]
AID - 10.1016/j.ijcard.2012.06.116 [doi]
PST - ppublish
SO  - Int J Cardiol. 2013 Sep 10;167(6):2695-9. doi: 10.1016/j.ijcard.2012.06.116. Epub 
      2012 Jul 26.