Effect of Beta-Blockers on Hospitalization in COPD and Concurrent Heart Failure

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Patients with chronic kidney disease were more likely to receive a prescription for carvedilol.
Patients with chronic kidney disease were more likely to receive a prescription for carvedilol.

Patients diagnosed with both heart failure (HF) and chronic obstructive pulmonary disease (COPD) treated with carvedilol may have a higher risk for hospitalization for HF compared with patients treated with metoprolol/bisoprolol/nebivolol, according to a study published in the European Journal of Heart Failure.

A total of 14,339 Danish patients (mean age, 72.6±9.9 years; 66.9% men) diagnosed with both HF and COPD were identified through the Danish National Patient Registry, Danish Registry of Medicinal Product Statistics, and National Causes of Death Registry. Investigators sought to determine the hazard ratio (HR) of hospitalization for COPD, HF, and all causes after 60 days of treatment with either carvedilol or metoprolol/bisoprolol/nebivolol.

Study results demonstrated that participants treated with carvedilol had a higher HR of being hospitalized for HF in both the unadjusted and adjusted analysis when compared with those treated with metoprolol/bisoprolol/nebivolol (HR, 1.74 [95% CI, 1.65-1.83] and HR, 1.61 [95% CI, 1.52-1.70], respectively). There were no statistically significant differences in hospitalization for COPD or all causes between participants treated with carvedilol vs metoprolol/bisoprolol/nebivolol.

The odds ratio (OR) of being hospitalized within 60 after carvedilol prescription redemption was found to be similar to that of those treated with metoprolol/bisoprolol/nebivolol (OR, 1.38 [95% CI, 1.23-1.56] and OR, 1.37 [95% CI, 1.27-1.48], respectively). Finally, it was found that patients with a history of chronic kidney disease had an increased frequency of receiving a prescription for carvedilol vs metoprolol/bisoprolol/nebivolol (OR, 1.16; 95% CI, 1.04-1.29).

Patients started on carvedilol had a 20% discontinuation rate compared with 8% in those treated with metoprolol/bisoprolol/nebivolol, with mean persistence duration rates of 507 and 815 days, respectively (P <.0001).

 

There is a possibility of a misdiagnosis between a COPD exacerbation vs HF decompensation, as it can be difficult for clinicians to distinguish between the similar symptoms. Therefore, misdiagnoses may have influenced the study data and results. This study was also observational and nonrandomized, which increases the risk for unmeasured confounders.

Researchers concluded that participants treated with carvedilol had an increased risk for hospitalization for HF compared with those treated with metoprolol, bisoprolol, or nebivolol. In addition, there were no statistically significant differences in hospitalization for COPD or all causes in patients in both groups. It was also found that patients were prescribed carvedilol, not in line with European Society of Cardiology guidelines, whereas multiple patients were not prescribed beta-blockers at all who may have benefited from them. Therefore, the importance of following European Society of Cardiology clinical guidelines for beta-blocker treatment needs to be emphasized to clinicians to maximize optimal outcomes for patients with HF and COPD.

Reference

Sessa M, Mascolo, A, Mortensen, RN, et al. Relationship between heart failure, concurrent chronic obstructive pulmonary disease and beta-blocker use: a Danish nationwide cohort study [published online November 20, 2017]. Eur J Heart Fail. doi:10.1002/ejhf.1045

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