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

Abstract

Background— Although β-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 β-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 β-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 β-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 β-blockers at the time of echocardiography. More patients randomized to the reminder had a subsequent β-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 β-blockers. Conclusions— A reminder attached to the echocardiography report increased the use of β-blockers in patients with depressed left ventricular systolic function.