NATIONAL PATTERNS AND PREDICTORS OF BETA-BLOCKER USE IN PATIENTS WITHCORONARY-ARTERY DISEASE

Background: Prior studies suggest underuse of beta-blockers in patient s with coronary artery disease, but these studies have been based on s elected populations of recently hospitalized patients. Objective: To d escribe national patterns and determinants of beta-blocker use in the ambulatory setting. Methods: We analyzed 11745 visits by patients with coronary artery disease to randomly selected, office-based physicians in the National Ambulatory Medical Care Surveys for 1980, 1981, 1985, and 1989 through 1996. We used multiple logistic regression to determ ine the independent effect of sociodemographic and clinical factors on beta-blocker use. Outcome Measure: beta-Blocker use at patient visits . Results: beta-Blocker use was reported in only 20.9% of office visit s by patients with coronary artery disease and no strong contraindicat ions between 1993 and 1996. In multivariate analyses, age younger than 75 years, residence in the Northeast, and visits to cardiologists and internists compared with family and general practitioners predicted g reater use of beta-blocker therapy. White race and private insurance a lso were significant predictors of beta-blocker use between 1980 and 1 996. Longitudinal analyses revealed a significant decline in beta-bloc ker use from 1980 to 1990, followed by a gradual increase in recent ye ars. Conclusions: beta-Blockers appear to be underused in ambulatory p atients with coronary artery disease. Our data suggest that nonclinica l factors may influence rates of use, indicating the need for closer s crutiny of variations in physician prescribing practices.