Effect of β-blockers on cardiac and pulmonary events and death in older adults with cardiovascular disease and chronic obstructive pulmonary disease

Abstract

Context: In older adults with multiple conditions, medications may not impart the same benefits seen in patients who are younger or without multimorbidity. Furthermore, medications given for one condition may adversely affect other outcomes. β-Blocker use with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is such a situation.

Objective: To determine the effect of β-blocker use on cardiac and pulmonary outcomes and mortality in older adults with coexisting COPD and CVD.

Design, setting, participants: The study included 1062 participants who were members of the 2004-2007 Medicare Current Beneficiary Survey cohorts, a nationally representative sample of Medicare beneficiaries. Study criteria included age over 65 years plus coexisting CVD and COPD/asthma. Follow-up occurred through 2009. We determined the association between β-blocker use and the outcomes with propensity score-adjusted and covariate-adjusted Cox proportional hazards.

Main outcome measures: The 3 outcomes were major cardiac events, pulmonary events, and all-cause mortality.

Results: Half of the participants used β-blockers. During follow-up, 179 participants experienced a major cardiac event; 389 participants experienced a major pulmonary event; and 255 participants died. Each participant could have experienced any ≥1 of these events. The hazard ratio for β-blocker use was 1.18 [95% confidence interval (CI), 0.85-1.62] for cardiac events, 0.91 (95% CI, 0.73-1.12) for pulmonary events, and 0.87 (95% CI, 0.67-1.13) for death.

Conclusion: In this population of older adults, β-blockers did not seem to affect occurrence of cardiac or pulmonary events or death in those with CVD and COPD.

FIGURE 1

Cumulative hazard plots for cardiac and pulmonary events and all-cause mortality by β-blocker use. Cumulative hazard plots display the total amount of risk (hazard) for each event accumulated up to each time point. The hazard ratios provided were estimated using Cox proportional hazard models adjusted by propensity score and year of entry for all models, with the addition of the total number of Elixhauser comorbidities to the COPD model and heart failure to the cardiac and all-cause mortality models. Follow-up was 3 years. Variables included in the propensity score are noted in Table 1. CI indicates confidence intervals; COPD, chronic obstructive pulmonary disease; HR, hazard ratio.