Impact of beta‐blocker use on the long‐term outcomes of heart failure patients with chronic obstructive pulmonary disease

Abstract

AimsThe number of patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) is increasing in Asia, and these conditions often coexist. We previously revealed a tendency of beta-blocker underuse among patients with HF with reduced ejection fraction (HFrEF) and COPD in Asian countries other than Japan. Here, we evaluated the impact of cardio-selective beta-blocker use on the long-term outcomes of patients with HF and COPD. Methods and results Among the 5232 patients with HFrEF (left ventricular ejection fraction of <40%) prospectively enrolled from 11 Asian regions in the ASIAN-HF registry, 412 (7.9%) had a history of COPD. We compared the clinical characteristics and long-term outcomes of the patients with HF and COPD according to the use and type of beta-blockers used: cardio-selective beta-blockers (n = 149) vs. non-cardio-selective beta-blockers (n = 124) vs. no beta-blockers (n = 139). The heart rate was higher, and the outcome was poorer in the no beta-blocker group than in the beta-blocker groups. The 2 year all-cause mortality was significantly lower in the non-cardio-selective beta-blocker group than in the no beta-blocker group. Further, the cardiovascular mortality significantly decreased in the non-cardio-selective beta-blocker group before (hazard ratio: 0.36; 95% confidence interval: 0.18-0.73; P = 0.004) and after adjustments (hazard ratio: 0.37; 95% confidence interval: 0.19-0.73; P = 0.005), but not in the cardio-selective beta-blocker group. Conclusions Beta-blockers reduced the all-cause mortality of patients with HFrEF and COPD after adjusting for age and heart rate, although the possibility of selection bias could not be completely excluded due to multinational prospective registry.

Epidemiology and treatment of heart failure with chronic obstructive pulmonary disease in Canadian primary care

“…Non-selective betablockers (such as carvedilol) are associated with greater airflow obstruction than cardioselective beta-blockers (such as bisoprolol, metoprolol, and nebivolol) 27 and less favourable outcomes in patients with HF and concurrent COPD. [28][29][30] While the Canadian Cardiovascular Society guidelines are silent regarding cardioselectivity in pulmonary disease, the European Society of Cardiology explicitly recommends cardioselective beta-blockers. The 11% of patients with HF and COPD in our cohort prescribed a non-cardioselective beta-blocker suggests an opportunity for more personalized care.…”

“…Every opportunity should therefore be taken to minimize risk of bronchoconstriction. Non‐selective beta‐blockers (such as carvedilol) are associated with greater airflow obstruction than cardioselective beta‐blockers (such as bisoprolol, metoprolol, and nebivolol) 27 and less favourable outcomes in patients with HF and concurrent COPD 28–30 . While the Canadian Cardiovascular Society guidelines are silent regarding cardioselectivity in pulmonary disease, the European Society of Cardiology explicitly recommends cardioselective beta‐blockers.…”

Analysis of pathogenesis and drug treatment of chronic obstructive pulmonary disease complicated with cardiovascular disease

“…A recent study on the effect of beta-blockers on the long-term prognosis of Asian COPD patients with heart failure showed that beta-blockers can reduce all-cause mortality in these patients. At the same time, active use of beta-blockers in such patients is advocated (87). Results of a recent large meta-analysis showed that betablockers are safe and reduce all-cause and in-hospital mortality in patients with COPD, and selective beta-blockers may even reduce the acute incidence of COPD.…”