Different impact of beta-blockers on long-term mortality in heart failure patients with and without chronic obstructive pulmonary disease

Satoshi Higuchi, Takashi Kono, Shun Kohsaka, Yasuyuki Shiraishi, Makoto Takei, Ayumi Goda, Satoshi Shoji, Yuji Nagatomo, Tsutomu Yoshikawa

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article number4378
JournalJournal of Clinical Medicine
Volume10
Issue number19
DOIs
Publication statusPublished - 2021 Oct 1

Keywords

  • Beta-blocker
  • Chronic obstructive pulmonary disease
  • Heart failure
  • Heart failure with mid-range ejection fraction
  • Heart failure with reduced ejection fraction

ASJC Scopus subject areas

  • Medicine(all)

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