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Association between β-blocker therapy and outcomes in patients hospitalised with acute exacerbations of chronic obstructive lung disease with underlying ischaemic heart disease, heart failure or hypertension
  1. Mihaela S Stefan1,2,3,4,
  2. Michael B Rothberg1,2,3,
  3. Aruna Priya5,
  4. Penelope S Pekow4,5,
  5. David H Au6,
  6. Peter K Lindenauer1,2,4
  1. 1Division of General Medicine, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
  2. 2Tufts University School of Medicine, Boston, Massachusetts, USA
  3. 3Program in Clinical and Translational Research, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Massachusetts, USA
  4. 4Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA
  5. 5School of Public Health and Health Sciences, University of Massachusetts-Amherst, Massachusetts, USA
  6. 6Pulmonary and Critical Care Division, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Mihaela S Stefan, Baystate Medical Center, 756 Chestnut Street, Springfield, MA 01199, USA; mihaela.stefan{at}bhs.org

Abstract

Background β-Blocker therapy has been shown to improve survival among patients with ischaemic heart disease (IHD) and congestive heart failure (CHF) and is underused among patients with chronic obstructive pulmonary disease (COPD). Evidence regarding the optimal use of β-blocker therapy during an acute exacerbation of COPD is particularly weak.

Methods We conducted a retrospective cohort study of patients aged ≥40 years with IHD, CHF or hypertension who were hospitalised for an acute exacerbation of COPD from 1 January 2006 to 1 December 2007 at 404 acute care hospitals throughout the USA. We examined the association between β-blocker therapy and in-hospital mortality, initiation of mechanical ventilation after day 2 of hospitalisation, 30-day all-cause readmission and length of stay.

Results Of 35 082 patients who met the inclusion criteria, 29% were treated with β blockers in the first two hospital days, including 22% with β1-selective and 7% with non-selective β blockers. In a propensity-matched analysis, there was no association between β-blocker therapy and in-hospital mortality (OR 0.88, 95% CI 0.71 to 1.09), 30-day readmission (OR 0.96, 95% CI 0.89 to 1.03) or late mechanical ventilation (OR 0.98, 95% CI 0.77 to 1.24). However, when compared with β1 selective β blockers, receipt of non-selective β blockers was associated with an increased risk of 30-day readmission (OR 1.25, 95% CI 1.08 to 1.44).

Conclusions Among patients with IHD, CHF or hypertension, continuing β1-selective β blockers during hospitalisation for COPD appears to be safe. Until additional evidence becomes available, β1-selective β blockers may be superior to treatment with a non-selective β blocker.

  • COPD
  • heart failure
  • ischaemic heart disease
  • β blockers
  • β2 agonists
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Footnotes

  • Funding MSS is supported by KM1 CA156726 from the National Cancer Institute (NCI) and by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1 RR025752. The content of this publication is solely the responsibility of the authors and does not represent the official views of NIH or NCI. The NIH or NCI had no role in the collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. DHA is supported by the Department of Veterans Affairs, Health Services Research and Development (HSR&D). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. DHA received grant funding from Gilead Sciences for work that is unrelated to this manuscript, and is a research consultant for Bosch LLC.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by IRB of Baystate Medical Center, Springfield, Massachusetts, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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