Beta-blocker use and COPD mortality: a systematic review and meta-analysis

Etminan, Mahyar; Jafari, Siavash; Carleton, Bruce; FitzGerald, J. Mark

doi:10.1186/1471-2466-12-48

Cited by 105 publications

(88 citation statements)

References 22 publications

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“…This postulation is provocative and untested, however prior evidence indirectly supports this idea. This may be the case of CPAP and its benefit on patients with overlap COPD-OSA, beta receptor-blockers and angiotensin-converting enzyme-inhibitor therapy and their potential impact in reducing mortality in patients with COPD and cardiovascular disease [40,47,48]. Our integrative method differs from previously published COPD comorbidities studies by the capacity of visualising a wide range of comorbidities rather than focussing on single or small number of them [14, 17, 20-22, 40, 49-54] and relating them to clinical variables.…”

Section: Discussionmentioning

confidence: 99%

COPD comorbidities network

et al. 2015

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Multimorbidity frequently affects the ageing population and their co-existence may not occur at random. Understanding their interactions and that with clinical variables could be important for disease screening and management.In a cohort of 1969 chronic obstructive pulmonary disease (COPD) patients and 316 non-COPD controls, we applied a network-based analysis to explore the associations between multiple comorbidities. Clinical characteristics (age, degree of obstruction, walking, dyspnoea, body mass index) and 79 comorbidities were identified and their interrelationships quantified. Using network visualisation software, we represented each clinical variable and comorbidity as a node with linkages representing statistically significant associations.The resulting COPD comorbidity network had 428, 357 or 265 linkages depending on the statistical threshold used ( p⩽0.01, p⩽0.001 or p⩽0.0001). There were more nodes and links in COPD compared with controls after adjusting for age, sex and number of subjects. In COPD, a subset of nodes had a larger number of linkages representing hubs. Four sub-networks or modules were identified using an interlinkage affinity algorithm and their display provided meaningful interactions not discernible by univariate analysis.COPD patients are affected by larger number of multiple interlinked morbidities which clustering pattern may suggest common pathobiological processes or be utilised for screening and/or therapeutic interventions. @ERSpublications COPD patients are affected by interlinked comorbidities forming structured networks

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Section: Discussionmentioning

confidence: 99%

COPD comorbidities network

et al. 2015

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][17][18][19][20] The possible mechanisms of the beneficial effects (cardioprotection mainly) of BB in the setting of COPD include: the presence of subclinical heart disease (ischemic heart disease, heart failure, arrhythmias etc. ), 5 the presence of clinically manifest heart disease, 10 the attenuation of cardiovascular side effects of beta-agonist medication, 11 and the correction of bronchial beta2-receptor down-regulation induced by beta-agonists. 21 The practical rules of using BBs in cardiac patients with concomitant COPD are as follows: (1) assessing the patient's pulmonary function (spirometry) before starting the treatment; (2) choosing a highly beta 1-selective agent (bisoprolol, nebivolol); and (3) applying the principle of "start low -go slow", as in the case of BB treatment in systolic heart failure, reaching the maximum tolerated dose in 2-week steps of up-titration.…”

Section: Discussionmentioning

confidence: 99%

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

Frigy

Mezei

Kocsis³

et al. 2016

Journal of Interdisciplinary Medicine

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Background: Recent scientific data demonstrated a potential beneficial effect of beta-blocker (BB) therapy in cardiac patients with chronic obstructive pulmonary disease (COPD). Our aim was to characterize the use of beta-blockers in these patients, in "real-life" conditions. Material and methods: We collected retrospectively the data of 60 consecutive cardiac patients (51 men, 9 women, mean age 67 years) with the concomitant diagnosis of COPD: main cardiac conditions, presence and reason of BB therapy, type of drug and dosage, main ECG and echocardiographic parameters, medication and data regarding COPD. Besides descriptive statistics, we compared the data of patients with and without BB therapy (chi-square test, level of significance alpha <0.05) in order to identify factors associated with BB usage. Results: In our study population, 41.6% of the patients had received BB treatment, the most frequently used drug being bisoprolol 2.5 mg and 5 mg q.d. (28%-28%), followed by carvedilol (32%). The prevalence of BB therapy was 51.2% in heart failure patients (48% in NYHA class III and IV, and 66.6% in dilated cardiomyopathy), 38.4% in hypertension, 81.8% in ischemic artery disease, and 64.7% in subjects with atrial fibrillation. The usage of BB therapy was significantly associated with the presence of heart failure (p = 0.047), dilated cardiomyopathy (p = 0.034), ischemic heart disease (p = 0.005), previous myocardial infarction (p = 0.003) and, inversely, with the acute exacerbation of COPD (p = 0.006). Conclusions: Despite the fact that every cardiac patient with COPD had a potential indication for BB treatment, this was used insufficiently, especially in case of heart failure patients. In daily practice, there is a need for continuous review and improvement of BB usage in these patients.

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“…Thirty-three participants were frequent exacerbators (2-7 exacerbations/year). 16 subjects who had ≤1 exacerbation prior to recruitment experienced 2-8 exacerbations in year one. One subject had 3 exacerbations prior to recruitment but experienced no exacerbations in year one.…”

Section: Methodsmentioning

confidence: 99%