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Use of beta-blockers in patients with an implantable cardioverter defibrillator.

Publication ,  Journal Article
LaPointe, NMA; Stafford, JA; Pappas, PA; Al-Khatib, SM; Anstrom, KJ
Published in: Ann Pharmacother
July 2009

BACKGROUND: Implantable cardioverter defibrillators (ICDs) are indicated for both primary and secondary prevention of sudden cardiac arrest. beta-Blockers are also indicated in most patients who have an indication for an ICD; however, their use in this population is not well described. Some clinicians may be unaware of the recommendation for beta-blockers in this population. OBJECTIVE: To explore beta-blocker use among ICD recipients. METHODS: Adults who received their first ICD at Duke Hospital between July 1999 and July 2004 for primary or secondary prevention of sudden cardiac arrest were identified. Using hospital data, beta-blocker use was determined at time of discharge, and characteristics of users were compared with those of nonusers. Continued use of beta-blockers after ICD implant was explored in the subset of patients included in the Duke Databank for Cardiovascular Disease (DDCD). RESULTS: The study cohort comprised 804 patients, 652 (81%) with ICD for secondary prevention of sudden cardiac arrest and 152 (19%) for primary prevention. The median age was 65 years and 75% of the patients were men. A total of 544 (68%) received a beta-blocker at time of ICD implant. There were no substantial changes in the proportion of patients with beta-blocker use from 1999 through 2004, overall or within the primary or secondary prevention groups. However, beta-blocker use was higher in the secondary prevention group than in the primary prevention group (69% vs 60%; p = 0.02). A higher proportion of beta-blocker users versus nonusers had ischemic heart disease (82% vs 68%; p < 0.0001), heart failure (84% vs 71%; p < 0.0001), previous myocardial infraction (51% vs 44%; p = 0.05), and ventricular arrhythmias (82% vs 76%; p = 0.04). Of the 425 patients included in the DDCD, only 241 (57%) were receiving beta-blockers at time of implant and during clinical follow-up. CONCLUSIONS: Lower than optimal use of beta-blockers suggests the need for new methods of including evidence-based medications in clinical practice, especially for complex patients for whom numerous clinical practice guidelines may apply.

Duke Scholars

Published In

Ann Pharmacother

DOI

EISSN

1542-6270

Publication Date

July 2009

Volume

43

Issue

7

Start / End Page

1189 / 1196

Location

United States

Related Subject Headings

  • Secondary Prevention
  • Retrospective Studies
  • Primary Prevention
  • Pharmacology & Pharmacy
  • Middle Aged
  • Male
  • Humans
  • Heart Diseases
  • Follow-Up Studies
  • Female
 

Citation

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LaPointe, N. M. A., Stafford, J. A., Pappas, P. A., Al-Khatib, S. M., & Anstrom, K. J. (2009). Use of beta-blockers in patients with an implantable cardioverter defibrillator. Ann Pharmacother, 43(7), 1189–1196. https://doi.org/10.1345/aph.1M140
LaPointe, Nancy M Allen, Judith A. Stafford, Paul A. Pappas, Sana M. Al-Khatib, and Kevin J. Anstrom. “Use of beta-blockers in patients with an implantable cardioverter defibrillator.Ann Pharmacother 43, no. 7 (July 2009): 1189–96. https://doi.org/10.1345/aph.1M140.
LaPointe NMA, Stafford JA, Pappas PA, Al-Khatib SM, Anstrom KJ. Use of beta-blockers in patients with an implantable cardioverter defibrillator. Ann Pharmacother. 2009 Jul;43(7):1189–96.
LaPointe, Nancy M. Allen, et al. “Use of beta-blockers in patients with an implantable cardioverter defibrillator.Ann Pharmacother, vol. 43, no. 7, July 2009, pp. 1189–96. Pubmed, doi:10.1345/aph.1M140.
LaPointe NMA, Stafford JA, Pappas PA, Al-Khatib SM, Anstrom KJ. Use of beta-blockers in patients with an implantable cardioverter defibrillator. Ann Pharmacother. 2009 Jul;43(7):1189–1196.
Journal cover image

Published In

Ann Pharmacother

DOI

EISSN

1542-6270

Publication Date

July 2009

Volume

43

Issue

7

Start / End Page

1189 / 1196

Location

United States

Related Subject Headings

  • Secondary Prevention
  • Retrospective Studies
  • Primary Prevention
  • Pharmacology & Pharmacy
  • Middle Aged
  • Male
  • Humans
  • Heart Diseases
  • Follow-Up Studies
  • Female