Beta-blocker prescription among Japanese cardiologists and its effect on various outcomes.

BACKGROUND Beta-blockers are underprescribed for coronary artery disease (CAD) patients in Japan. Considering the vast amount of evidence showing their benefits in this group of patients, the aim of the present study was to investigate the use of beta-blockers in a large cohort of CAD patients. METHODS AND RESULTS The 13,812 patients with angiographically confirmed CAD were followed up for 2.7 years. From this group, 4,160 (30.1%) patients were prescribed beta-blockers at the time of discharge. These patients were significantly more likely to have hypertension, hyperlipidemia, obesity, a family history of ischemic diseases and a higher number of diseased arteries. The rate of continuation for beta-blockers was 90.8%. A propensity score matching analysis showed no additional benefits of beta-blockers in reducing all-cause mortality, cardiac events and cerebrovascular events. Lipophilic beta-blockers were significantly more effective than hydrophilic ones in reducing all-cause mortality (hazard ratio 0.467, 95% confidence interval 0.247-0.880, P=0.019). CONCLUSIONS Despite the low prescription rate of beta-blockers for CAD patients among Japanese physicians, the continuation rate was relatively high. Lipophilic beta-blockers may be a better choice than hydrophilic beta-blockers in terms of mortality risk, although a randomized control study would need to be conducted to verify this assertion.

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