![]() Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. Addressing these barriers may require development, testing, and dissemination of protocols for beta-blocker initiation and up-titration that are safe and appropriate in primary care. ![]() Many barriers to guideline concordant use of beta-blockers among patients with HFrEF identified by primary care providers are not readily modifiable. Barriers to up-titration included treatment/side effects (49% of available votes), patient communication/buy-in (21%), polypharmacy (13%), and healthcare system barriers (8%). Treatment/side effects, particularly hypotension, were identified as the most important barrier for beta-blocker use (72% of available votes) followed by polypharmacy (11%), healthcare system barriers (10%), and comorbidities (6%). ResultsFifteen of 16 participating primary care physicians who completed the survey reported that management of beta-blockers was their responsibility. The percentage of available votes was calculated for each theme. Investigators characterized items into themes. Each participant had six votes with three votes assigned to the item ranked most important, two to the second most important item, and one to the third most important item. Participants generated lists of barriers to beta-blocker use and up-titration among patients with HFrEF. We conducted 4 moderated, structured group discussions among 19 primary care physicians using the nominal group technique 16 participants also completed a survey. Our purpose was to identify and rank barriers to beta-blocker use and up-titration from the perspective of primary care physicians. However, many patients with HFrEF do not use beta-blockers and up-titration is rare. PurposeFor patients with heart failure with reduced ejection fraction (HFrEF), guidelines recommend use of beta-blockers with gradual up-titration.
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