β-Blockers Improve Survival of Patients With Chronic Obstructive Pulmonary Disease After Coronary Artery Bypass Grafting

Angeloni, Emiliano; Melina, Giovanni; Roscitano, Antonino; Refice, Simone; Capuano, Fabio; Lechiancole, Andrea; Comito, Cosimo; Benedetto, Umberto; Sinatra, Riccardo

doi:10.1016/j.athoracsur.2012.07.080

Cited by 28 publications

(35 citation statements)

References 32 publications

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“…2 In patients with chronic obstructive pulmonary disease undergoing CABG, β-blocker administration significantly improved survival at the midterm follow-up. 27 …”

Section: Discussionmentioning

confidence: 99%

Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery

et al. 2015

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“…2 In patients with chronic obstructive pulmonary disease undergoing CABG, β-blocker administration significantly improved survival at the midterm follow-up. 27 …”

Section: Discussionmentioning

confidence: 99%

Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery

et al. 2015

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“…12 Despite these safety concerns, a growing body of observational studies suggests that BBs may have cardioprotective effects in COPD patients. [13][14][15][16][17][18][19][20][21][22] One meta-analysis of observational studies reported a 36% reduction in allcause mortality associated with BB use in patients with coronary heart disease and COPD. 23 However, these studies have important methodological limitations.…”

Section: -6 CV Risk Reduction Ismentioning

confidence: 99%

“…23 However, these studies have important methodological limitations. In particular, most of these studies focused on prevalent users of BBs [13][14][15][16][17][18][19][20][21][22] and used non-users of BBs as the comparator group. [13][14][15][16][17][18][19][20][21] Patients who remain on BB treatment for a long time may be less susceptible to an outcome of interest as compared to those just starting the drug.…”

Section: -6 CV Risk Reduction Ismentioning

confidence: 99%

“…Cardioselective BBs were chosen as the exposure of interest in alignment with prior studies. [13][14][15][16][17][18][19][20][21][22] Initiators of non-DHP CCBs were selected as the referent group since guidelines recommend non-DHP CCB treatment in patients with ACS who have a contraindication to BBs and have no other contraindications (eg, severe left ventricular dysfunction). 30 31 We excluded patients without continuous enrolment for at least 180 days before the ACS hospitalisation admission date (see the online supplementary materials for details), those with age <20 years (Optum, RER, NHI) or 65 years (PACE, PAAD) or more than 120 years, and those who simultaneously initiated study drugs from both exposure groups on the index date.…”

Section: Study Population and Study Drugsmentioning

confidence: 99%

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Evidence of potential bias in a comparison of β blockers and calcium channel blockers in patients with chronic obstructive pulmonary disease and acute coronary syndrome: results of a multinational study

et al. 2017

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ObjectivesA number of observational studies have reported that, in patients with chronic obstructive pulmonary disease (COPD), β blockers (BBs) decrease risk of mortality and COPD exacerbations. To address important methodological concerns of these studies, we compared the effectiveness and safety of cardioselective BBs versus non-dihydropyridine calcium channel blockers (non-DHP CCBs) in patients with COPD and acute coronary syndromes (ACS) using a propensity score (PS)-matched, active comparator, new user design. We also assessed for potential unmeasured confounding by examining a short-term COPD hospitalisation outcome.Setting and participantsWe identified 22 985 patients with COPD and ACS starting cardioselective BBs or non-DHP CCBs across 5 claims databases from the USA, Italy and Taiwan.Primary and secondary outcome measuresStratified Cox regression models were used to estimate HRs for mortality, cardiovascular (CV) hospitalisations and COPD hospitalisations in each database after variable-ratio PS matching. Results were combined with random-effects meta-analyses.ResultsCardioselective BBs were not associated with reduced risk of mortality (HR, 0.90; 95% CI 0.78 to 1.02) or CV hospitalisations (HR, 1.06; 95% CI 0.91 to 1.23), although statistical heterogeneity was observed across databases. In contrast, a consistent, inverse association for COPD hospitalisations was identified across databases (HR, 0.54; 95% CI 0.47 to 0.61), which persisted even within the first 30 days of follow-up (HR, 0.55; 95% CI 0.37 to 0.82). Results were similar across a variety of sensitivity analyses, including PS trimming, high dimensional-PS matching and restricting to high-risk patients.ConclusionsThis multinational study found a large inverse association between cardioselective BBs and short-term COPD hospitalisations. The persistence of this bias despite state-of-the-art pharmacoepidemiologic methods calls into question the ability of claims data to address confounding in studies of BBs in patients with COPD.

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“…• La enfermedad coronaria es una indicación absoluta para el uso de beta-bloqueadores (15,16,21,22), pero en el paciente con enfermedad pulmonar obstructiva crónica este tipo de antagonismo se consideraba contraindicado.…”

Section: Introductionunclassified

Uso de beta-bloqueadores en pacientes con enfermedad pulmonar obstructiva crónica

Osorio

2013

rev. colomb. neumol.

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Uso de beta-bloqueadores en pacientes con enfermedad pulmonar obstructiva crónicaUse of beta-blockers in patients with COPD RESUMEN La enfermedad pulmonar obstructiva crónica (EPOC) es un síndrome sistémico con múltiples fenotipos, en el que la enfermedad cardiovascular contribuye significativamente a la morbilidad y la mortalidad por su causa. El tabaquismo, la clase socioeconómica baja y un estilo de vida sedentario contribuyen a la historia natural de cada una de estas condiciones. La mayoría de las enfermedades cardiovasculares requieren tratamiento con beta-bloqueadores, que tradicionalmente se han contraindicado en los pacientes con EPOC; sin embargo el uso de estos fármacos se asocia a beneficios y mejores resultados en pacientes con enfermedades cardiovasculares, hipertensión, insuficiencia cardiaca, enfermedad coronaria y enfermedad pulmonar obstructiva crónica.Palabras clave: receptores adrenérgicos, beta-bloqueadores, enfermedad pulmonar obstructiva crónica, falla cardiaca. ABSTRACTChronic obstructive pulmonary disease (COPD) is a systemic syndrome with multiple phenotypes. Cardiovascular disease contributes significantly to the morbidity and mortality of COPD. Tobacco use, low socioeconomic class, and sedentary lifestyle contribute to the natural history of each of these conditions. Most cardiovascular diseases require treatment with beta-blockers. Traditionally, beta-blockers have been contraindicated in patients with COPD. However, the use of these drugs is associated with benefits and better results in patients with cardiovascular diseases, hypertension, heart failure, coronary disease, and COPD.

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β-Blockers Improve Survival of Patients With Chronic Obstructive Pulmonary Disease After Coronary Artery Bypass Grafting

Cited by 28 publications

References 32 publications

Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery

Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery

Evidence of potential bias in a comparison of β blockers and calcium channel blockers in patients with chronic obstructive pulmonary disease and acute coronary syndrome: results of a multinational study

Uso de beta-bloqueadores en pacientes con enfermedad pulmonar obstructiva crónica

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