Self-reported and actual beta-blocker prescribing for heart failure patients: Physician predictors

Background: Beta-blockers reduce mortality among patients with systolic heart failure (HF), yet primary care provider prescription rates remain low. Objective: To examine the association between primary care physician characteristics and both self-reported and actual prescription of beta-blockers among patients with systolic HF. Design: Cross-sectional survey with supplementary retrospective chart review. Participants: Primary care providers at three New York City Veterans Affairs medical centers. Measurements: Main outcomes were: 1) self-reported prescribing of beta-blockers, and 2) actual prescribing of betablockers among HF patients. Physician HF practice patterns and confidence levels, as well as socio-demographic and linical characteristics, were also assessed. Results: Sixty-nine of 101 physicians (68%) completed the survey examining self-reported prescribing of beta-blockers. Physicians who served as inpatient ward attendings self-reported significantly higher rates of beta-blocker prescribing among their HF patients when compared with physicians who did not attend (78% vs. 58%; p=0.002), as did physicians who were very confident in managing HF patients when compared with physicians who were not (82% vs. 68%; p=0.009). Fifty-one of these 69 surveyed physicians (74%) were successfully matched to 287 HF patients for whom beta-blocker prescribing data was available. Physicians with greater self-reported rates of prescribing beta-blockers were significantly more likely to actually prescribe beta-blockers (p =0.02); however, no other physician characteristics were significantly associated with actual prescribing of beta-blockers among HF patients. Conclusions: Physician teaching responsibilities and confidence levels were associated with self-reported beta-blocker prescribing among their HF patients. Educational efforts focused on improving confidence levels in HF care and increasing exposure to teaching may improve beta-blocker presciption in HF patients managed in primary care.