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

被引:69
作者
Lipworth, Brian [1 ]
Skinner, Derek [2 ]
Devereux, Graham [3 ]
Thomas, Victoria [4 ]
Jie, Joanna Ling Zhi [5 ]
Martin, Jessica [6 ]
Carter, Victoria [2 ]
Price, David B. [5 ,7 ]
机构
[1] Univ Dundee, Scottish Ctr Resp Res, Dundee, Scotland
[2] Optimum Patient Care, Cambridge, England
[3] Univ Aberdeen, Appl Hlth Sci, Aberdeen, Scotland
[4] Cambridge Res Support, Cambridge, England
[5] Observat & Pragmat Res Inst, Singapore, Singapore
[6] Res Real Life, Cambridge, England
[7] Univ Aberdeen, Ctr Acad Primary Care, Aberdeen, Scotland
基金
英国医学研究理事会;
关键词
MYOCARDIAL-INFARCTION; ASSOCIATION; SELECTIVITY; MORTALITY; SURVIVAL; GENOTYPE; OUTCOMES; THERAPY; COPD;
D O I
10.1136/heartjnl-2016-309458
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective Although beta-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 beta-blockers. We wished to assess the real-life use of beta-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 beta-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 beta-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 beta-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with beta-blockers (n=778) versus 46% taking an ACEI/ARB without beta-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 beta-blockers more often for concomitant HF.
引用
收藏
页码:1909 / 1914
页数:6
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