Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease

Abstract

ObjectiveAlthough β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-blockers for patients with HF and comorbid COPD.MethodsWe evaluated data from the Optimum Patient Care Research Database over a period of 1 year for co-prescribing of β-blockers with either an ACE inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) in patients with HF alone versus HF+COPD. Association with inhaler therapy was also evaluated.ResultsWe identified 89 861 patients with COPD, 24 237 with HF and 10 853 with both conditions. In patients with HF+COPD, the mean age was 79 years; 60% were male, and 27% had prior myocardial infarction. Of patients with HF+COPD, 22% were taking a β-blocker in conjunction with either ACEI/ARB (n=2416) compared with 41% of patients with HF only (n=10 002) (adjusted OR 0.54, 95% CI 0.51 to 0.58, p<0.001). Among HF+COPD patients taking inhaled corticosteroid (ICS) with long-acting β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-blockers (n=1316). Corresponding figures for those patients taking ICS/LABA were 20% (n=583) versus 48% (n=1367), respectively.ConclusionsThese data indicate a substantial unmet need for patients with COPD who should be prescribed β-blockers more often for concomitant HF.

Evidence‐based pharmacotherapies used in the postdischarge phase are associated with improved one‐year survival in senior patients hospitalized with heart failure

“…However, previous studies have highlighted that suboptimal HF pharmacotherapy is prevalent and there is often a risk-treatment mismatch where elderly patients at greatest risk of death after hospitalized HF are also less likely to receive a RASI or β-blocker. 23,24 Almost one-third of our cohort had a history of COPD which is the most powerful predictor of underuse of β-blockers in HF, 25 even though cardioselective β-blockers can be safely used in the majority of HF patients with COPD with the same mortality benefits. 26…”

Characteristics of Beta-blocker Treatment in Cardiac Patients with Concomitant Chronic Obstructive Pulmonary Disease

“…only half of the COPD patients remain on chronic BB therapy after an episode of acute coronary syndrome. [9][10][11][12] In our patients the underutilization of BBs in heart failure was striking. However, in the setting of ischemic heart disease, the BB usage was proper.…”

Commencement of cardioselective beta‐blockers during hospitalisation for acute exacerbations of chronic obstructive pulmonary disease

“…[16][17][18][19][20] Despite this, recent studies have demonstrated continuing under-prescription in suitable COPD patients with clear indications for beta-blocker therapy. 21,22 The safety of introducing beta-blockers during periods of acute respiratory illness, such as an acute exacerbation of COPD, remains unresolved. 8,23 To examine this, we performed a retrospective cohort study to assess the safety of beta-blocker initiation in patients admitted to hospital with an acute exacerbation of COPD.…”