Physician Perspectives on the Use of Beta Blockers in Heart Failure With Preserved Ejection Fraction.

ABSTRACT

ß-blockers are commonly used in heart failure with preserved ejection fraction (HFpEF), even in the absence of a compelling indication and despite the potential to cause harm. Identifying reasons for ß-blocker prescription in HFpEF could permit the development of strategies to reduce unnecessary use and potentially improve medication prescribing patterns in this vulnerable population. We administered an online survey regarding ß-blocker prescribing behavior to physicians trained in internal medicine or geriatrics (noncardiology physicians) and to cardiologists at 2 large academic medical centers. The survey assessed the reasons for ß-blocker initiation, agreement regarding initiation and/or continuation of ß-blockers by another clinician, and deprescribing behavior. The response rate was 28.2% (n = 231). Among respondents, 68.2% reported initiating ß-blockers in patients with HFpEF. The most common reason for initiating a ß-blocker was for treatment of an atrial arrhythmia. Notably, 23.7% of physicians reported initiating a ß-blocker without an evidence-based indication. When a ß-blocker was considered not necessary, 40.1% of physicians reported they were rarely or never willing to deprescribe. The most common reason for not deprescribing a ß-blocker when the physician felt that a ß-blocker was unnecessary was the concern about interfering with another physicians' treatment plan (76.6%). In conclusion, a significant proportion of noncardiology physicians and cardiologists report prescribing ß-blockers to patients with HFpEF, even when evidence-based indications are absent, and rarely deprescribe ß-blockers in these scenarios.