In Reply Dr Miyares raises several excellent points, correctly noting that our study sample may include persons receiving β-blocker therapy prior to admission who had treatment temporarily withheld early during hospitalization. Without access to outpatient pharmacy claims, we could not ascertain the proportion of our study sample in this category. However, even in the unlikely scenario that three-quarters of our sample had received β-blocker therapy prior to hospitalization, our findings still imply that many thousands of patients hospitalized for acute heart failure in the United States are initiated on β-blocker treatment despite potential contraindications. In addition, the receipt of β-blocker therapy prior to hospitalization does not imply that reinitiating treatment prior to discharge is necessarily safe. This finding has yet to be demonstrated and would require a large, prospective clinical trial to avoid confounding.
Dharmarajan K, Krumholz HM. Caution Warranted When Defining Contraindications in Initiating β-Blocker Therapy—Reply. JAMA Intern Med. 2014;174(3):481-482. doi:10.1001/jamainternmed.2013.13685