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PLoS One. 2009 Dec 31;4(12):e8522. doi: 10.1371/journal.pone.0008522.

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

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  • 1Department of Medicine, James J. Peters VA Medical Center, Bronx, New York, USA.



Beta-blockers reduce mortality among patients with systolic heart failure (HF), yet primary care provider prescription rates remain low.


To examine the association between primary care physician characteristics and both self-reported and actual prescription of beta-blockers among patients with systolic HF.


Cross-sectional survey with supplementary retrospective chart review.


Primary care providers at three New York City Veterans Affairs medical centers.


MAIN OUTCOMES WERE: 1) self-reported prescribing of beta-blockers, and 2) actual prescribing of beta-blockers among HF patients. Physician HF practice patterns and confidence levels, as well as socio-demographic and clinical characteristics, were also assessed.


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.


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.

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