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. 2017 Oct 17:12:3041-3046.
doi: 10.2147/COPD.S144333. eCollection 2017.

Beta-blocker under-use in COPD patients

Kuan Pin Lim  1   2 , Sarah Loughrey  1 , Michael Musk  1   2 , Melanie Lavender  1   2 , Jeremy P Wrobel  1   2   3
Affiliations

Beta-blocker under-use in COPD patients

Kuan Pin Lim et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Cardiovascular (CVS) comorbidities are common in COPD and contribute significantly to morbidity and mortality, especially following acute exacerbations of COPD (AECOPD). Beta-blockers (BBs) are safe and effective in COPD patients, with demonstrated survival benefit following myocardial infarction. We sought to determine if BBs are under-prescribed in patients hospitalized with AECOPD. We also sought to determine inpatient rates of CVS and cerebrovascular complications, and their impact on patient outcomes.

Methods: Retrospective hospital data was collected over a 12-month period. The medical records of all patients >40 years of age coded with a diagnosis of AECOPD were analyzed. Prevalent use and incident initiation of BBs were assessed. Comorbidities including indications and contraindications for BB use were analyzed.

Results: Of the 366 eligible patients, 156 patients (42.6%) had at least one indication for BB use - of these patients, only 53 (34.0%) were on BB therapy and 61 (39.1%) were not on BB therapy but had no listed contraindication. Prevalent use of BBs at the time of admission in all 366 patients was 19.7%, compared with 45.6%, 39.6% and 45.9% use of anti-platelets, statins and angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers, respectively. CVS and cerebrovascular complications were common in this population (57 patients, 16%) and were associated with longer length of stay (p<0.01) and greater inpatient mortality (p=0.02).

Conclusions: BBs are under-prescribed in COPD patients despite clear indication(s) for their use. Further work is required to explore barriers to BB prescribing in COPD patients.

Keywords: COPD exacerbations; beta-blockers; cardiovascular; comorbidity.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
CONSORT diagram. Note: Text/data shown in bold are the important points. Abbreviation: BB, beta-blocker.
Figure 2
Figure 2
Clinical endpoints for AECOPD patients stratified by incidence of cardiovascular or cerebrovascular events. Abbreviations: AECOPD, acute exacerbation of chronic obstructive pulmonary disease; CVS, cardiovascular; CVA, cerebrovascular; ICU, intensive care unit.
See this image and copyright information in PMC

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