Optimizing beta-blocker therapy in cardiovascular care: a national cross-sectional assessment of physicians' and nurses' knowledge, attitudes, and practices in Saudi Arabia.

INTRODUCTION

Beta-blockers are a cornerstone of guideline directed medical therapy for cardiovascular diseases; however, their underutilization remains a global concern. Healthcare professionals' knowledge, attitudes, and practices play a critical role in optimizing beta-blocker prescribing and monitoring. This study aimed to assess the knowledge, attitudes, and practices of physicians and nurses regarding beta-blocker use in cardiovascular patients in Saudi Arabia.

METHODS

A national cross-sectional study was conducted among physicians and nurses working in government hospitals across Saudi Arabia. Data were collected using a structured self-administered questionnaire assessing demographics, knowledge, attitudes and practices related to beta-blocker use and monitoring. Descriptive statistics, group comparisons, and multivariable linear regression analyses were performed.

RESULTS

A total of 553 healthcare professionals participated, including 249 physicians (45.0%) and 304 nurses (55.0%). The median knowledge score was 6.0 (IQR: 5.0-8.0). Nurses demonstrated higher knowledge in titration principles (79.3% vs. 59.8%, p < 0.001) and recognition of rebound effects (74.3% vs. 65.5%, p = 0.014). In contrast, physicians showed greater knowledge in appropriate beta-blocker selection (52.2% vs. 40.8%, p = 0.008) and were more likely to correctly identify that beta-blockers are not contraindicated in all patients with diabetes (42.6% vs. 31.9%, p = 0.017). Fear of adverse effects, particularly bradycardia and hypotension, was more frequently reported among nurses (58.6% vs. 36.1%, p < 0.001). Participants with 1-5 years (β = 0.61, 95% CI: 0.14-1.07, p = 0.010) and 6-10 years (β = 0.69, 95% CI: 0.03-1.35, p = 0.040) had higher knowledge scores, while frequent patient management was associated with lower knowledge (β = -0.85, 95% CI, -1.52 to -0.18, p = 0.013). Attitude scores were lower among nurses (β = -1.28, 95% CI, -2.08 to -0.48, p = 0.002) and those managing patients less frequently (β = -1.64, 95% CI, -2.99 to -0.28, p = 0.018).

CONCLUSION

Healthcare professionals in Saudi Arabia demonstrated moderate knowledge regarding beta-blocker therapy, with distinct professional differences in knowledge domains and perceived barriers. Fear of adverse effects emerged as a key obstacle to optimal beta-blocker use, particularly among nurses. Targeted educational interventions, unified institutional protocols, and enhanced interprofessional collaboration are needed to improve adherence to guideline-directed beta-blocker therapy and optimize cardiovascular outcomes.