Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Abstract

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37–0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76–2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations.

Gender Differences in Potentially Inappropriate Medication Use among Older Adults

“…For instance, a retrospective analysis of 4713 hospitalized patients with chronic kidney disease (CKD) aged ≥65 years reported that 21.9% were taking at least one inappropriate medication at the time of hospital admission, which was linked to multiple medication use and end-stage CKD [ 1 ]. Another study on patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD) found a significant underuse of beta-blockers among older patients [ 2 ]. Moreover, the study identified cases of inappropriate prescribing of beta-blockers, including the use of contraindicated medications, affecting approximately 30% of patients with HF and COPD.…”

Pharmacotherapies in Older Adults with COPD: Challenges and Opportunities

“…Despite the clinical and pharmacological rationale suggesting the use of β-blockers in most patients with HF, it was reported that in hospitalized older patients (median age 82.8 years) affected by HF and COPD, only 36.9% were receiving a β-blocker on admission. This percentage became 38.0% at discharge, and there were no other β-blocker users after discharge [ 66 ]. These percentages were significantly lower than those observed in patients affected by HF alone (51.3 and 51.7%, respectively).…”

Reports of Symptoms Associated with Supraventricular Arrhythmias as a Serious Adverse Drug Reaction in the Spanish Pharmacovigilance Database

“…Spontaneous reporting of suspected ADRs can create an agile and rapid system for identifying potential ADRs that have not yet been identified, known in pharmacovigilance as “signal generation”. This is of particular importance, especially in an ageing population, where the prevalence of multimorbidity (co-existence of two or more chronic conditions) and polypharmacy (the concomitant use of multiple medications) is continuously increasing, resulting in a higher risk of additional morbidity, potentially inappropriate medication, and drug-related adverse events [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The “signals” of potential drug-related side effects and adverse reactions can be further studied in depth by regulatory authorities, as well as the participation of notifiers [ 21 , 22 ].…”