Beta Blockers in Concomitant Heart Failure and Chronic Obstructive Pulmonary Disease: Are We Getting It Right?

The administration of beta-blockers is challenging and their efficacy is unclear in heart failure (HF) patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the association of beta-blockers with mortality in such patients. This multicenter observational cohort study included hospitalized HF patients with a left ventricular ejection fraction <50% and evaluated them retrospectively. COPD was diagnosed based on medical records and/or the clinical judgment of each investigator. The study endpoints were two-year all-cause, cardiac, and non-cardiac mortality. This study included 83 patients with COPD and 1760 patients without. Two-year all-cause, cardiac, and non-cardiac mortality were observed in 315 (17%), 149 (8%), and 166 (9%) patients, respectively. Beta-blockers were associated with lower all-cause mortality regardless of COPD (COPD: hazard ratio [HR] 0.39, 95% CI 0.16–0.98, p = 0.044; non-COPD: HR 0.62, 95% CI 0.46–0.83, p = 0.001). This association in HF patients with COPD persisted after multivariate analysis and inverse probability weighting and was due to lower non-cardiac mortality (HR 0.40, 95% CI 0.14–1.18. p = 0.098), not cardiac mortality (HR 0.37, 95% CI 0.07–2.01, p = 0.248). Beta-blockers were associated with lower all-cause mortality in HF patients with COPD due to lower non-cardiac mortality. This may reflect selection biases in beta-blocker prescription.

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The use of beta-blockers in patients with chronic obstructive pulmonary disease and chronic heart failure in real clinical practice

South Russian Journal of Therapeutic Practice ◽

10.21886/2712-8156-2021-2-1-70-75 ◽

2021 ◽

Vol 2 (1) ◽

pp. 70-75

Author(s):

N. A. Karoli ◽

A. V. Borodkin ◽

A. P. Rebrov

Keyword(s):

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Clinical Practice ◽

Chronic Heart Failure ◽

Pulmonary Disease ◽

Beta Blockers ◽

Dose Titration ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Real Clinical Practice

Objective: to reveal the features of the use of beta-blockers (BB) in patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) in real clinical practice.Materials and methods: the study included 90 patients with COPD and CHF, and 41 patients with CHF of ischemic genesis without COPD.Results: patients with COPD and CHF were significantly less likely to receive beta-blockers (BB) compared with patients with CHF. Of the BB patients with COPD and CHF were primarily prescribed bisoprolol, its average dose was 4.45 ± 1.74 mg per day. Patients with COPD and CHF of ischemic genesis of BB were prescribed significantly more often, and diuretics were significantly less likely than patients with COPD and CHF without myocardial infarction. Patients with COPD and CHF with ejection fraction of the left ventricle (LVEF) more than 40% were less likely to take BB than patients with COPD and CHF with reduced EF (less than 40%), and also less frequently, than patients with CHF without COPD with LVEF more than 40%.Conclusion: BB, as first-line drugs in the treatment of CHF, was prescribed on an outpatient basis only to half of patients with COPD and CHF, which does not comply with current guidelines for the management of patients with comorbid conditions. In the vast majority of cases, highly selective BB were prescribed. It should be noted low doses of BB, the absence of dose titration, which does not correspond to modern recommendations for the treatment of chronic heart failure.

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Beta Blockers and Chronic Obstructive Pulmonary Disease (COPD): Sum of Evidence

Current Hypertension Reviews ◽

10.2174/1573402116999201209203250 ◽

2020 ◽

Vol 16 ◽

Author(s):

Katerina Baou ◽

Vasiliki Katsi ◽

Thomas Makris ◽

Dimitris Tousoulis

Keyword(s):

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Coronary Artery Disease ◽

Pulmonary Disease ◽

Cardiac Arrhythmias ◽

Beta Blockers ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Artery Disease

Abstract:: Approximately, half a century has passed since the discovery of beta blockers. Then, their prime therapeutic purpose was to treat angina and cardiac arrhythmias, nowadays, beta blockers’ usage and effectiveness is extended to treat other cardiovascular diseases, such as hypertension, congestive heart failure, and coronary artery disease. Safety concerns were raised about beta blockers and their use for chronic obstructive pulmonary disease (COPD) patients with concurrent cardiovascular disease. After a thorough research of the literature, this review summarizes the evidence proving that beta blockers not only might be well tolerated in COPD patients, but they might also have a beneficial effect in this group of patients.

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Challenges of Treating Acute Heart Failure in Patients with Chronic Obstructive Pulmonary Disease

Cardiac Failure Review ◽

10.15420/cfr.2016:23:2 ◽

2017 ◽

Vol 03 (01) ◽

pp. 56 ◽

Cited By ~ 9

Author(s):

Jelena Čelutkienė ◽

Mindaugas Balčiūnas ◽

Denis Kablučko ◽

Liucija Vaitkevičiūte ◽

Jelena Blaščiuk Vaitkevičiūte ◽

...

Keyword(s):

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Beta Blockers ◽

Skeletal Muscle Atrophy ◽

Chronic Obstructive ◽

Low Grade ◽

Clinical Expertise ◽

Obstructive Pulmonary Disease ◽

Low Grade Inflammation

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) comorbidity poses substantial diagnostic and therapeutic challenges in acute care settings. The specific role of pulmonary comorbidity in the treatment and outcomes of cardiovascular disease patients was not addressed in any short- or long-term prospective study. Both HF and COPD can be interpreted as systemic disorders associated with low-grade inflammation, endothelial dysfunction, vascular remodelling and skeletal muscle atrophy. HF is regularly treated as a broader cardiopulmonary syndrome utilising acute respiratory therapy. Based on observational data and clinical expertise, a management strategy of concurrent HF and COPD in acute settings is suggested. Concomitant use of beta2-agonists and beta-blockers in a comorbid cardiopulmonary condition seems to be safe and effective.

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