Beta blockers are underused in patients receiving implantable cardioverter defibrillators
Research Activities, March 2010, No. 355
Implantable cardioverter defibrillators (ICDs) are most commonly used in patients who also have conditions for which beta blockers are recommended. In fact, ICDs are only supposed to be used for primary prevention of sudden cardiac arrest (SCA) in patients who have had their beta blocker therapy optimized. However, only 68 percent of patients received a beta blocker during the hospitalization in which their ICD was implanted and only 72 percent received a beta blocker in the 2 years after their ICD implant, according to Nancy M. Allen LaPointe, Pharm.D., and colleagues at Duke University. They examined beta blocker use among 652 patients who received ICDs for secondary prevention of SCA and 152 patients who received ICDs for primary prevention of SCA between July 1999 and July 2004 at Duke Hospital. The median age of the patients was 65 years and 75 percent were men.
An ICD is recommended for patients with cardiac arrest or ventricular tachycardia/fibrillation for secondary prevention of SCA and in patients with left ventricular systolic dysfunction with or without ischemic heart disease (IHD) for primary prevention of SCA. Beta blockers are recommended in patients with IHD, heart failure, and many different types of ventricular arrhythmias—many of whom also have an indication for an ICD.
The researchers found less than optimal use of beta blockers for these patients, with 69 percent of the secondary prevention group receiving beta blockers and 60 percent of the primary prevention group receiving the medication. They concluded that there appears to be a substantial lack of compliance with evidence-based recommendations for beta blocker use among ICD recipients, which may result in poorer clinical outcomes. The study was supported in part by the Agency for Healthcare Research and Quality (HS10548).
See "Use of beta-blocker in patients with an implantable cardioverter defibrillator," by Dr. LaPointe, Judith A. Stafford, M.S., Paul A. Pappas, M.S., and others in The Annals of Pharmacotherapy 43, pp. 1189-1196, 2009.