OBJECTIVE: Beta-blocker utilization in patients with mild to moderate congestive heart failure (CHF) substantially improves left ventricular ejection fraction and patient symptoms and reduces overall mortality. Carvedilol and extended-release metoprolol succinate are the only beta-blocking agents currently indicated in the US for CHF patients. Both agents have shown similar risk reduction in overall and cause-specific mortality; however, no comparative outcomes data for the two agents are available. This study identifies current utilization patterns (agent/dosing regimens) of beta-blocker therapy in the CHF population at Scott & White Health Plan. METHODS: Health plan pharmacy claims data were retrospectively reviewed for calendar year 2002 for beta-blocker prescribing patterns for CHF patients (identified by ICD-9 codes). Specifically, pharmacy claims were evaluated for inclusion of beta-blockers as standard therapy for CHF, use of FDA-approved versus off-label use of beta-blockers for CHF, and use of recommended doses. RESULTS: Approximately 1700 health plan CHF patients were identified; 40% of those patients had a prescription filled for a beta-blocker during 2002. Of the CHF patients receiving a beta-blocker, less than 45% were prescribed either of the two indicated agents (carvedilol or extended-release metoprolol succinate) for CHF. Furthermore, less than 40% of patients prescribed either carvedilol or extended-release metoprolol succinate achieved target CHF doses. Thus, of those CHF patients currently on beta-blocker therapy, less than 17% received an appropriate regimen. CONCLUSIONS: This evaluation illustrates that less than ten percent of CHF patients in this managed care plan are receiving optimal beta-blocker therapy. Future quality improvement efforts should be focused on provider-based educational initiatives to improve beta-blocker prescribing patterns in the CHF population. Increased use of beta-blocker therapy in patients identified with CHF would significantly improve the morbidity and mortality associated with this disease.