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β blockers for heart failure

BMJ 2016; 353 doi: (Published 20 April 2016) Cite this as: BMJ 2016;353:i2074
  1. Arno W Hoes, professor of clinical epidemiology and general practice
  1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands
  1. Correspondence to: a.w.hoes{at}

End under-prescribing for women and older adults

In their linked article, Kotecha and colleagues (doi:10.1136/bmj.i1855) present a meta-analysis of individual patient data (IPD) and conclude that β blockers reduce all cause mortality and admission to hospital related to heart failure in patients with heart failure with reduced ejection fraction (HFrEF) and in sinus rhythm, irrespective of age and sex.1 These findings reinforce the recommendations of current clinical guidelines.2 3 In daily clinical practice, however, prescription rates of β blockers and the doses taken are lower than might be expected based on the available evidence. β blockers seem to be underused, especially in women and older adults of both sexes. Studies from secondary care clearly show suboptimal prescribing, although reported prescription rates vary considerably.4 5 In primary care, uptake of β blockers is even lower.6 7

Kotecha and colleagues included nearly all the available evidence from trials comparing β blockers with placebo, with individual data from 13 833 patients including 3283 women and more than 4000 adults aged 70-80. …

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