Different Impact of Beta-Blockers on Long-Term Mortality in Heart Failure Patients with and without Chronic Obstructive Pulmonary Disease.
Satoshi HiguchiTakashi KohnoShun KohsakaYasuyuki ShiraishiMakoto TakeiAyumi GodaSatoshi ShojiYuji NagatomoTsutomu YoshikawaPublished in: Journal of clinical medicine (2021)
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.
Keyphrases
- chronic obstructive pulmonary disease
- ejection fraction
- left ventricular
- lung function
- heart failure
- aortic stenosis
- cardiovascular events
- newly diagnosed
- end stage renal disease
- risk factors
- prognostic factors
- healthcare
- acute coronary syndrome
- hypertrophic cardiomyopathy
- cardiovascular disease
- acute myocardial infarction
- air pollution
- cross sectional