Cardiologists are more willing to prescribe ß-blockers than respiratory physicians: an Australasian clinical scenario survey.

ABSTRACT

BACKGROUND/AIMS: Recent data show great benefit from beta adrenergic blocking drug (ß-blocker) use in heart failure and has resulted in increased use of these established agents. Older data caution against their use in patients with reversible airways disease because of risks of bronchoconstriction. Anecdotally, we noted a difference in willingness to prescribe ß-blockers by cardiologists and respiratory physicians, especially for patients with coexisting airways disease. We sought to test this difference. METHODS: Nine clinical scenarios were created, tested and emailed to all members of the Cardiac and Thoracic societies of Australasia. Scenarios combined varying degrees of benefit and risk (bronchoconstriction). An inducement to return questionnaires was applied. RESULTS: Cardiologists and respiratory physicians were similarly willing to prescribe ß-blockers for patients at little risk of bronchoconstriction, irrespective of potential benefit. Cardiologists were more willing to prescribe ß-blockers than respiratory physicians for patients at greater risk of bronchoconstriction, particularly when the potential therapeutic benefit was greater. CONCLUSIONS: Our perception that cardiologists were more willing to prescribe ß-blockers than respiratory physicians was confirmed. This probably results from a difference in focus (namely focus on benefit by cardiologists vs focus on risk by respiratory physicians), although other factors including awareness of limitations of pulmonary function testing by respiratory physicians may have been involved. Until better tests are available (that discriminate between patients who are likely to suffer bronchoconstriction from those who are not), it is likely that this difference between the specialties will remain.