Clinical Reminders Attached to Echocardiography Reports of Patients With Reduced Left Ventricular Ejection Fraction Increase Use of -Blockers: A Randomized Trial

Department of Medicine, Stanford University, Palo Alto, California, United States
Circulation (Impact Factor: 14.43). 06/2007; 115(22):2829-34. DOI: 10.1161/CIRCULATIONAHA.106.684753
Source: PubMed


Although beta-blockers are known to prolong survival for patients with reduced left ventricular ejection fraction, they are often underused. We hypothesized that a reminder attached to the echocardiography report would increase the use of beta-blockers for patients with reduced left ventricular ejection fraction.
We randomized 1546 consecutive patients with a left ventricular ejection fraction <45% found on echocardiography at 1 of 3 laboratories to a reminder for use of beta-blockers or no reminder. Patients were excluded from analysis if they died within 30 days of randomization (n=89), did not receive medications through the Veterans Affairs system after 30 days (n=180), or underwent echocardiography at >1 laboratory (n=6). The primary outcome was a prescription for an oral beta-blocker between 1 and 9 months after randomization. The mean age of the 1271 included patients was 69 years; 60% had a history of heart failure, and 51% were receiving treatment with beta-blockers at the time of echocardiography. More patients randomized to the reminder had a subsequent beta-blocker prescription (74%, 458 of 621) compared with those randomized to no reminder (66%, 428 of 650; P=0.002). The effect of the reminder was not significantly different for subgroups based on patient location (inpatient versus outpatient) or prior use of beta-blockers.
A reminder attached to the echocardiography report increased the use of beta-blockers in patients with depressed left ventricular systolic function.

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    • "Thirty-seven trials [16,18,19,21-23,26,27,29-33,35-38,40,41,43,45,48,50,52-54,57-59,62,63,65,68,70,73-75,80,81,87,89] of 59 (63%) showed improvement in process of care outcomes due to CCDSS use. No significant difference was found between Rx-only (23/33) [18,22,23,26,30,32,33,35-38,41,43,48,50,54,58,62,65,68,73,81,87,89] and multi-faceted (14/26) [16,19,21,27,29,31,40,45,52,53,57,59,63,70,74,75,80] CCDSSs for process of care improvement. "
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    • "Then, complementary echocardiography combined with a visit by a cardiologist should complete the strategy. In a randomized trial, Heinderich et al. demonstrated that clinical reminders attached to echocardiography reports increased the use of beta-blockers (74% versus 66%) for patients with reduced left ventricular ejection fraction [16]. Echocardiography reports should be as comprehensive as possible. "
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