Impact of β-blocker selectivity on long-term outcomes in congestive heart failure patients with chronic obstructive pulmonary disease

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is present in approximately one-third of all congestive heart failure (CHF) patients, and is a key cause of underprescription and underdosing of β-blockers, largely owing to concerns about precipitating respiratory deterioration. For these reasons, the aim of this study was to evaluate the impact of β-blockers on the long-term outcomes in CHF patients with COPD. In addition, we compared the effects of two different β-blockers, carvedilol and bisoprolol.MethodsThe study was a retrospective, non-randomized, single center trial. Acute decompensated HF patients with COPD were classified according to the oral drug used at discharge into β-blocker (n=86; carvedilol [n=52] or bisoprolol [n=34]) and non-β-blocker groups (n=46). The primary endpoint was all-cause mortality between the β-blocker and non-β-blocker groups during a mean clinical follow-up of 33.9 months. The secondary endpoints were the differences in all-cause mortality and the hospitalization rates for CHF and/or COPD exacerbation between patients receiving carvedilol and bisoprolol.ResultsThe mortality rate was higher in patients without β-blockers compared with those taking β-blockers (log-rank P=0.039), and univariate analyses revealed that the use of β-blockers was the only factor significantly correlated with the mortality rate (hazard ratio: 0.41; 95% confidence interval: 0.17–0.99; P=0.047). Moreover, the rate of CHF and/or COPD exacerbation was higher in patients treated with carvedilol compared with bisoprolol (log-rank P=0.033). In the multivariate analysis, only a past history of COPD exacerbation significantly increased the risk of re-hospitalization due to CHF and/or COPD exacerbation (adjusted hazard ratio: 3.11; 95% confidence interval: 1.47–6.61; P=0.003).ConclusionThese findings support the recommendations to use β-blockers in HF patients with COPD. Importantly, bisoprolol reduced the incidence of CHF and/or COPD exacerbation compared with carvedilol.

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

“…In the case of heart diseases with indication for BB and concomitant COPD, selective BBs proved to have a more consistent beneficial effect than those without beta 1-selectivity. [13][14][15][16][17] Finally, epidemiological studies and meta-analyses clearly demonstrated in non-selected COPD populations (with or without heart diseases) that BB treatment decreased mortality and acute exacerbations of COPD. [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.…”

Effectiveness and safety of concurrent beta-blockers and inhaled bronchodilators in COPD with cardiovascular comorbidities

“…Moreover, bisoprolol reduced the incidence of heart failure and/or COPD exacerbation compared with carvedilol in a retrospective longitudinal analysis [21]. Although there is a high tolerance of β 1 -selective blockers and certain benefits in cardioprotection, their prescription should always be preceded by a careful evaluation of each patient's characteristics, and follow a proper and safe drug dosage.…”

Treatment of comorbid chronic obstructive pulmonary disease and cardiovascular disease

“…После внедрения в клини ческую практику высокоселективных БАБ (бисо пролол, метопролол, небиволол) ограничение в на значении этой группы препаратов перестало быть однозначным [7][8][9]. По результатам исследова ний [10][11][12] продемонстрировано, что при исполь зовании высокоселективных БАБ снижается риск сердечно сосудистых осложнений при коморбид ности ХОБЛ с ССЗ. Более того, получены данные, свидетельствующие о том, что в случае длительного приема БАБ улучшается выживаемость и снижается риск развития обострений у различных категорий пациентов с ХОБЛ.…”

“…В исследовании [11] назначение БАБ в течение 7 лет (n = 4 086) пациентам с ХОБЛ и инфарктом миокар да (ИМ) в анамнезе сопровождалось снижением смертности от всех причин. В работе Y.Kubota et al [12] также продемонстрировано положительное влияние БАБ на уровень летальности у пациентов с ХОБЛ и ХСН. При этом важно отметить, что бисопролол был эффективнее карведилола.…”