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Comparative Study
. 2016 Dec 1;102(23):1909-1914.
doi: 10.1136/heartjnl-2016-309458. Epub 2016 Jul 5.

Underuse of β-Blockers in Heart Failure and Chronic Obstructive Pulmonary Disease

Affiliations
Free PMC article
Comparative Study

Underuse of β-Blockers in Heart Failure and Chronic Obstructive Pulmonary Disease

Brian Lipworth et al. Heart. .
Free PMC article

Abstract

Objective: Although β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-blockers for patients with HF and comorbid COPD.

Methods: We evaluated data from the Optimum Patient Care Research Database over a period of 1 year for co-prescribing of β-blockers with either an ACE inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) in patients with HF alone versus HF+COPD. Association with inhaler therapy was also evaluated.

Results: We identified 89 861 patients with COPD, 24 237 with HF and 10 853 with both conditions. In patients with HF+COPD, the mean age was 79 years; 60% were male, and 27% had prior myocardial infarction. Of patients with HF+COPD, 22% were taking a β-blocker in conjunction with either ACEI/ARB (n=2416) compared with 41% of patients with HF only (n=10 002) (adjusted OR 0.54, 95% CI 0.51 to 0.58, p<0.001). Among HF+COPD patients taking inhaled corticosteroid (ICS) with long-acting β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-blockers (n=1316). Corresponding figures for those patients taking ICS/LABA were 20% (n=583) versus 48% (n=1367), respectively.

Conclusions: These data indicate a substantial unmet need for patients with COPD who should be prescribed β-blockers more often for concomitant HF.

Conflict of interest statement

BL reports grants and personal fees from Chiesi, personal fees from Boerhingher Ingelheim, grants and personal fees from Meda, grants and personal fees from Teva, grants from Janssen, grants from AstraZeneca, grants from Roche, outside the submitted work; VT reports other from Cambridge Research Support, outside the submitted work; JL reports other from Observational and Pragmatic Research Institute, during the conduct of the study; JM reports other from Research in Real Life, outside the submitted work; DBP has board membership with Aerocrine, Almirall, Amgen, AstraZeneca plc, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis International AG and Teva. Consultancy: A Almirall, Amgen, AstraZeneca plc, Boehringer Ingelheim, Chiesi, GlaxoSmithKline plc, Meda, Mundipharma, Napp, Novartis International AG, Pfizer and Teva; Grants and unrestricted funding for investigator-initiated studies from UK National Health Service, British Lung Foundation, Aerocrine, AKL, Almirall, AstraZeneca plc, Boehringer Ingelheim, Chiesi, Eli Lilly, GlaxoSmithKline plc, Meda, Merck & Co., Mundipharma, Napp, Novartis International AG, Orion, Pfizer, Respiratory Effectiveness Group, Takeda, Teva and Zentiva; Payments for lectures/speaking: Almirall, AstraZeneca plc, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline plc, Kyorin, Meda, Merck & Co., Mundipharma, Novartis International AG, Pfizer, SkyePharma, Takeda and Teva; Payment for manuscript preparation: Mundipharma and Teva; Patents (planned, pending or issued): AKL; Payment for the development of educational materials: GlaxoSmithKline plc, Novartis International AG; Stock/Stock options: Shares in AKL which produces phytopharmaceuticals and owns 80% of Research in Real Life and its subsidiary social enterprise Optimum Patient Care; received payment for travel/accommodations/meeting expenses from Aerocrine, Boehringer Ingelheim, Mundipharma, Napp, Novartis International AG and Teva; Funding for patient enrolment or completion of research: Almirral, Chiesi, Teva and Zentiva; Peer reviewer for grant committees: Medical Research Council (2014), Efficacy and Mechanism Evaluation programme (2012), HTA (2014).

Figures

Figure 1
Figure 1
Patient inclusion and exclusion criteria. COPD, chronic obstructive pulmonary disorder; HF, heart failure; OPCRD, Optimum Patient Care Research Database.
Figure 2
Figure 2
Prescription of β-blocker (BB) and ACEI (ACE inhibitor) or angiotensin-2 receptor blocker (ARB) for patients with heart failure (HF) alone versus patients with HF and chronic obstructive pulmonary disease (COPD)—showing data for all patients and split by New York Heart Association (NYHA) class. Data for adjusted ORs are shown with 95% CI.
Figure 3
Figure 3
Use of β-blockers in chronic obstructive pulmonary disease/heart failure according to inhaler therapy. Dark bars depict patients taking ACE inhibitor (ACEI)/ angiotensin-2 receptor blocker (ARB) without β-blockers, while lighter bars depict patients taking ACEI/ARB with β-blockers. The absolute numbers of patients are also shown. Error bars depict 95%CI. Also see table 2 for additional numerical data. ICS, inhaled corticosteroids; LABA, long-acting β-2 agonist; LAMA, long-acting muscarinic antagonist; SABA, short-acting β-2 agonist; SAMA, short-acting muscarinic antagonist.

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