Community patients with heart failure (HF) are older, less often treated by HF specialists, and have more comorbidity than those in randomized clinical trials. These differences might affect β-blocker prescribing in HF.

To explore patterns of β-blocker prescribing for HF in the community and their association with outcomes, we determined carvedilol doses at end titration in 4113 patients from a community-based β-blocker HF registry according to physician and patient characteristics, HF severity, and rates of hospitalization and death.

Female sex, age ≥65 years, and left ventricular ejection fraction ≥35% were associated with lower β-blocker doses. Average daily dose of β-blocker was lower with worse baseline New York Heart Association class. More patients of cardiologists achieved carvedilol doses ≥25 mg twice daily, whereas in those of noncardiologists lower doses were more common. Relative risk of HF hospitalizations or all-cause death was significantly lower with higher doses of β-blocker.

β-Blocker dosing in community HF appears lower than in randomized clinical trials, especially when prescribed by noncardiologists. At all doses, patients taking the β-blocker carvedilol have a lower incidence of death and HF hospitalization than those discontinuing it, regardless of physician type in the community setting.