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(Circulation. 2007;115:2829-2834.)
© 2007 American Heart Association, Inc.

Health Services and Outcomes Research

Clinical Reminders Attached to Echocardiography Reports of Patients With Reduced Left Ventricular Ejection Fraction Increase Use of ß-Blockers

A Randomized Trial

Paul A. Heidenreich, MD, MS; Parisa Gholami, MPH; Anju Sahay, PhD; Barry Massie, MD; Mary K. Goldstein, MD, MS

From the VA Palo Alto Health Care System (P.A.H., P.G., A.S., M.K.G.) and Department of Medicine, Stanford University (P.A.H., M.K.G.), Stanford, Calif; and San Francisco VA Medical Center and Department of Medicine, University of California at San Francisco (B.M.), San Francisco, Calif.

Reprint requests to Paul A. Heidenreich, MD, 111C Cardiology, Palo Alto VA Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304. E-mail heiden{at}stanford.edu

Received December 15, 2006; accepted April 3, 2007.

Background— Although ß-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 ß-blockers for patients with reduced left ventricular ejection fraction.

Methods and Results— 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 ß-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 ß-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 ß-blockers at the time of echocardiography. More patients randomized to the reminder had a subsequent ß-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 ß-blockers.

Conclusions— A reminder attached to the echocardiography report increased the use of ß-blockers in patients with depressed left ventricular systolic function.

Key Words: adrenergic beta-antagonists • echocardiography • health services research • heart failure • reminder systems

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