Association between â-blocker therapy and outcomes in patients hospitalised with acute exacerbations of chronic obstructive lung disease with underlying ischaemic heart disease, heart failure or hypertension
BACKGROUND: Î²-Blocker therapy has been shown to improve survival among patients with ischaemic heart disease (IHD) and congestive heart failure (CHF) and is underused among patients with chronic obstructive pulmonary disease (COPD). Evidence regarding the optimal use of Î²-blocker therapy during an acute exacerbation of COPD is particularly weak. METHODS: We conducted a retrospective cohort study of patients aged â‰¥40 years with IHD, CHF or hypertension who were hospitalised for an acute exacerbation of COPD from 1 January 2006 to 1 December 2007 at 404 acute care hospitals throughout the USA. We examined the association between Î²-blocker therapy and in-hospital mortality, initiation of mechanical ventilation after day 2 of hospitalisation, 30-day all-cause readmission and length of stay. RESULTS: Of 35â€ˆ082 patients who met the inclusion criteria, 29% were treated with Î² blockers in the first two hospital days, including 22% with Î²1-selective and 7% with non-selective Î² blockers. In a propensity-matched analysis, there was no association between Î²-blocker therapy and in-hospital mortality (OR 0.88, 95% CI 0.71 to 1.09), 30-day readmission (OR 0.96, 95% CI 0.89 to 1.03) or late mechanical ventilation (OR 0.98, 95% CI 0.77 to 1.24). However, when compared with Î²1 selective Î² blockers, receipt of non-selective Î² blockers was associated with an increased risk of 30-day readmission (OR 1.25, 95% CI 1.08 to 1.44). CONCLUSIONS: Among patients with IHD, CHF or hypertension, continuing Î²1-selective Î² blockers during hospitalisation for COPD appears to be safe. Until additional evidence becomes available, Î²1-selective Î² blockers may be superior to treatment with a non-selective Î² blocker.
Stefan MS, Rothberg MB, Priya A, Pekow PS, Au DH, Lindenauer PK. Association between â-blocker therapy and outcomes in patients hospitalised with acute exacerbations of chronic obstructive lung disease with underlying ischaemic heart disease, heart failure or hypertension Thorax 2012 Nov;67(11):977-84.