Beta-blocker use and the risk of death in hospitalized patients with acute exacerbations of COPD

Abstract

Background: Cardiovascular disease is a major cause of death among COPD patients and predicts hospitalization for acute exacerbation, in-hospital death, and post-discharge mortality. Although beta-blockers improve cardiovascular outcomes, COPD patients often do not receive them due to concerns about possible adverse pulmonary effects. There are no published data about beta-blocker use among inpatients with COPD exacerbations. We aimed to identify factors associated with beta-blocker use in this setting and to determine whether their use is associated with decreased in-hospital mortality. Methods: We reviewed administrative data from the University of Alabama Hospital and identified patients admitted between October 1999 and September 2006 with acute exacerbation of COPD as primary diagnosis or as secondary diagnosis with a primary diagnosis of acute respiratory failure. Demographics, co-morbidities, and medication use were recorded and subjects receiving beta-blockers were compared to those who did not. Multivariate regression analysis was performed to determine predictors of in-hospital death after controlling for known covariates and the propensity to receive beta-blockers. Results: 825 patients met inclusion criteria. In-hospital mortality was 5.2%. Those receiving beta-blockers (n=142) were older and more frequently had cardiovascular disease than those who did not. In multivariate analysis adjusting for potential confounders including the propensity score, beta-blocker use was associated with reduced mortality (OR=0.39; 95% CI: 0.14-0.99). Age, length of stay, number of prior exacerbations, the presence of respiratory failure, congestive heart failure, cerebrovascular disease, or liver disease also predicted in-hospital mortality (p<0.05). Conclusions: Beta-blocker use among inpatients with exacerbations of COPD is well tolerated and may be associated with reduced mortality. The potential protective effect of beta-blockers in this population warrants further study.