β-blockers after acute myocardial infarction in patients with chronic obstructive pulmonary disease: A nationwide population-based observational study

Abstract

Background Patients with chronic obstructive pulmonary disease (COPD) less often receive β-blockers after acute myocardial infarction (AMI). This may influence their outcomes after AMI. This study evaluated the efficacy of β-blockers after AMI in patients with COPD, compared with non-dihydropyridine calcium channel blockers (NDCCBs) and absence of these two kinds of treatment. Methods and results We conducted a nationwide population-based cohort study using data retrieved from Taiwan National Health Insurance Research Database. We collected 28,097 patients with COPD who were hospitalized for AMI between January 2004 and December 2013. After hospital discharge, 24,056 patients returned to outpatient clinics within 14 days (the exposure window). Those who received both β-blockers and NDCCBs (n = 302) were excluded, leaving 23,754 patients for analysis. Patients were classified into the β-blocker group (n = 10,638, 44.8%), the NDCCB group, (n = 1,747, 7.4%) and the control group (n = 11,369, 47.9%) based on their outpatient prescription within the exposure window. The β-blockers group of patients had lower overall mortality risks (adjusted hazard ratio [95% confidence interval]: 0.91 [0.83–0.99] versus the NDCCB group; 0.88 [0.84–0.93] versus the control group), but the risk of major adverse cardiac events within 1 year was not statistically different. β-blockers decreased risks of re-hospitalization for COPD and other respiratory diseases by 12–32%. Conclusions The use of β-blockers after AMI was associated with a reduced mortality risk in patients with COPD. β-blockers did not increase the risk of COPD exacerbations.

Beta-Blockers in High-Risk Outpatients with Chronic Obstructive Pulmonary Disease are Associated with All-Cause Mortality – The STATUETTE Cohort Study

“…Furthermore, differences in study design, including adjustment for immortal time bias, may very well explain differing results, as immortal time bias often leads to intervention risk reduction in pharmacoepidemiologic studies. 22 Of note, mortality reduction has been reported in an observational study by Su et al, 28 despite correction for immortal time bias, in COPD patients hospitalized with a diagnosis of AMI.…”

β-Blockers and the Rate of Chronic Obstructive Pulmonary Disease Exacerbations

“…In all, 7 studies, 4 classified as cohort design, 16-20 1 cross-sectional study, 21 and 1 meta-analysis 22 demonstrated a decreased COPD exacerbation rate among those prescribed a β-blocker. 16-21 The studies did not exclude for CVD and most of the patients who received a β-blocker also had CVD. 16-21 The average age of the patients in the study ranged between 60.8 and 79.5 years.…”

“…Su et al 20 conducted the most recent retrospective cohort study utilizing the Taiwan National Health Insurance Database. There were 23 754 patients who were analyzed.…”

“…[16][17][18][19][20][21] The studies did not exclude for CVD and most of the patients who received a β-blocker also had CVD. [16][17][18][19][20][21] The average age of the patients in the study ranged between 60.8 and 79.5 years. [16][17][18][19][20][21][22] Similar to the aforementioned studies that focused on exacerbation rates, the results for each study are presented separately because of variation in reporting format by the study authors.…”

“…[16][17][18][19][20][21] The average age of the patients in the study ranged between 60.8 and 79.5 years. [16][17][18][19][20][21][22] Similar to the aforementioned studies that focused on exacerbation rates, the results for each study are presented separately because of variation in reporting format by the study authors. The summarized results demonstrating a beneficial effect can be found in Table 3.…”