Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease

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


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.

Publication types

  • Comparative Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic beta-2 Receptor Agonists / therapeutic use
  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Aged, 80 and over
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Bronchodilator Agents / therapeutic use
  • Databases, Factual
  • Drug Therapy, Combination
  • Drug Utilization Review
  • Female
  • Guideline Adherence / trends
  • Heart Failure / complications
  • Heart Failure / diagnosis
  • Heart Failure / drug therapy*
  • Humans
  • Male
  • Muscarinic Antagonists / therapeutic use
  • Polypharmacy
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / trends*
  • Primary Health Care
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Retrospective Studies
  • Secondary Care
  • Time Factors
  • United Kingdom


  • Adrenal Cortex Hormones
  • Adrenergic beta-2 Receptor Agonists
  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Bronchodilator Agents
  • Muscarinic Antagonists