Although beta-blockers are known to prolong survival for patients with reduced left ventricular ejection fraction, their use in the community and the VA is suboptimal. We hypothesized that a reminder attached to the echocardiography report would increase the use of beta-blockers among patients with depressed left ventricular function.
We randomized 657 consecutive patients undergoing echocardiography at one of three VA echocardiography laboratories with reduced left ventricular ejection fraction (
The mean age of the 492 included patients was 68 years, 99% were male, 75% had hypertension, 40% had diabetes, 68% had ischemic heart disease, and 67% had a history of heart failure. Angiotensin receptor blockers or converting enzyme inhibitors were used in 68% and beta-blockers were used in 50% at the time of randomization. At six months following randomization, more patients randomized to the reminder were treated with beta-blockers (69%, 172/248), compared to those randomized to no reminder (59%, 145/244, p=0.02). Carvedilol was the beta-blocker used in 25% and metoprolol tartrate in 24%, atenolol in 13% and metoprolol succinate in 3%.
A reminder attached to the echocardiography report increased the use of beta-blockers for patients with depressed left ventricular ejection fraction. Attaching reminders to diagnostic test reports is inexpensive and is easily implemented by any echocardiography laboratory using the existing reporting mechanism (e.g. dictation, computer generation). Reminders attached to diagnostic test reports should now be evaluated in a regional demonstration project.