Beta-blocker dosing in community-based treatment of heart failure

Am Heart J. 2007 Jun;153(6):1029-36. doi: 10.1016/j.ahj.2007.03.010.


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 beta-blocker prescribing in HF.

Methods: To explore patterns of beta-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 beta-blocker HF registry according to physician and patient characteristics, HF severity, and rates of hospitalization and death.

Results: Female sex, age > or = 65 years, and left ventricular ejection fraction > or = 35% were associated with lower beta-blocker doses. Average daily dose of beta-blocker was lower with worse baseline New York Heart Association class. More patients of cardiologists achieved carvedilol doses > or = 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 beta-blocker.

Conclusions: Beta-blocker dosing in community HF appears lower than in randomized clinical trials, especially when prescribed by noncardiologists. At all doses, patients taking the beta-blocker carvedilol have a lower incidence of death and HF hospitalization than those discontinuing it, regardless of physician type in the community setting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage*
  • Aged
  • Carbazoles / administration & dosage*
  • Carvedilol
  • Community Networks / statistics & numerical data
  • Drug Administration Schedule
  • Drug Prescriptions / statistics & numerical data
  • Female
  • Heart Failure / classification
  • Heart Failure / drug therapy*
  • Heart Failure / mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Propanolamines / administration & dosage*
  • Severity of Illness Index
  • Survival Rate
  • United States


  • Adrenergic beta-Antagonists
  • Carbazoles
  • Propanolamines
  • Carvedilol