The prescription of beta-blockers in older patients with heart failure with reduced ejection fraction: an observational study in Vietnam

This study in older hospitalized patients with heart failure with reduced ejection fraction (HFrEF) aimed to examine the prevalence of beta-blocker prescription and its associated factors. A total of 190 participants were recruited from July 2019 to July 2020. The inclusion criteria included: (1) aged ≥ 60 years, (2) having a diagnosis of chronic HFrEF in the medical records, (3) hospitalized for at least 48 h. The participants had a mean age of 75.5 ± 9.1, and 46.8% were female. Of these, 55.3% were prescribed beta-blockers during admission. To explore the factors associated with beta-blocker prescription, multivariable logistic regression analysis was applied and the results were presented as odds ratios (OR) and 95% confidence intervals (CI). On multivariate logistic regression models, higher NYHA classes (OR 0.49, 95%CI 0.26–0.94), chronic obstructive pulmonary disease (OR 0.17, 95% CI 0.04–0.85), chronic kidney disease (OR 0.40, 95% CI 0.19–0.83), and heart rate under 65 (OR 0.34, 95% CI 0.12–0.98) were associated with a reduced likelihood of prescription. In this study, we found a low rate of beta-blocker prescriptions, with only around half of the participants being prescribed beta-blockers. Further studies are needed to examine the reasons for the under-prescription of beta-blockers, and to evaluate the long-term benefits of beta-blockers in elderly patients with HFrEF in this population.


Outcome definition
The outcome of this study was the prescription of evidence-based beta-blockers for the treatment of HFrEF (including bisoprolol, carvedilol, metoprolol, nebivolol).Beta-blocker prescription was defined based on the medical records during admission.

Predictive variables
The potential variables that can be associated with the prescription of beta-blockers included age, sex, body mass index, New York Heart Association (NYHA) classes, heart rate, comorbidities including hypertension, ischemic heart disease, atrial fibrillation, valvular heart disease, dilated cardiomyopathy, diabetes, dyslipidemia, chronic obstructive pulmonary disease, and chronic kidney disease.

Statistical analysis
Analysis of the data was performed using SPSS for Windows 29.0 (IBM Corp., Armonk, NY, USA).Continuous variables are presented as means ± standard deviation, and categorical variables as frequencies and percentages.Comparisons between groups (with and without beta-blocker prescriptions) were conducted using the Chi-square test or Fisher's exact test for categorical variables and Student's t-test or Mann-Whitney test for continuous variables.
To explore the factors associated with beta-blocker prescription, multivariable logistic regression analysis was applied.First, univariable logistic regression was performed on all the potential associated factors in the dataset, based on clinical rationale (such as age, sex, comorbidities, NYHA classes, and comorbidities).Variables that had a p-value < 0.05 on univariable analysis were selected for multivariable analysis.
Results were presented as odds ratios (OR) and 95% confidence intervals (CI).

Table 1 .
General characteristics.NYHA, New York Heart Association; NT-proBNP, N-terminal pro b-type natriuretic peptide; eGFR, estimated glomerular filtration rate; PAPs, pulmonary artery pressure; LVEF, Left ventricular ejection fraction.Continuous variables are presented as means ± standard deviation, and categorical variables as frequencies and percentages.Prescription rates of beta-blockers by comorbidity types.

Table 2 .
Prescriptions of other heart failure medications.Categorical variables are presented as frequencies and percentages.ACEIs: angiotensin-converting enzyme inhibitors, ARBs: angiotensin receptor blockers, MRAs: mineralocorticoid receptor antagonists

Table 3 .
Univariable logistic regressions of potentially associated factors for beta-blocker prescription.