In patients with heart failure (HF) with chronic obstructive pulmonary disease (COPD),
concerns exist regarding β blockers, particularly noncardioselective β blockers, precipitating
bronchospasm or attenuating the benefit of inhaled β2 agonists. The aim of this study was to test the hypothesis that noncardioselective
β blockers would not be associated with worse outcomes compared with cardioselective
β blockers in patients with concomitant COPD in a large HF registry. A retrospective
analysis of patients from the Organized Program to Initiate Lifesaving Treatment in
Hospitalized Patients With Heart Failure (OPTIMIZE-HF) who had systolic dysfunction,
documentation of β-blocker status, and follow-up information available after index
hospitalization (n = 2,670) was performed. The associations between cardioselective
and noncardioselective β blockers and the end points of 60- to 90-day mortality and
mortality or rehospitalization in patients with (n = 722) and without (n = 1,948)
COPD were analyzed using regression modeling. The models were adjusted for covariate
predictors of β-blocker use at discharge and clinical predictors of outcomes. Noncardioselective
and cardioselective β blockers were associated with lower risk-adjusted mortality
in patients with and without COPD. There was no evidence that β-blocker selectivity
was associated with a difference in outcomes between patients with and those without
COPD (p for interaction >0.10 for both outcomes). In conclusion, despite concerns
regarding β blockers in patients with HF with COPD, there was no evidence that β-blocker
selectivity was associated with differences in outcomes for patients with HF with
COPD versus those without.
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Article info
Publication history
Published online: December 03, 2012
Accepted:
October 22,
2012
Received in revised form:
October 22,
2012
Received:
September 21,
2012
Footnotes
The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF; ClinicalTrials.gov identifier NCT00344513) was funded by GlaxoSmithKline, Philadelphia, Pennsylvania.
See page 586 for disclosure information.
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Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
