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Chronic obstructive pulmonary disease
Original research
Beta-blocker use and acute exacerbations of COPD following myocardial infarction: a Danish nationwide cohort study
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  1. Daniel B Rasmussen1,2,3,
  2. Uffe Bodtger1,3,4,
  3. Morten Lamberts2,
  4. Christian Torp-Pedersen5,6,
  5. Gunnar Gislason7,8,9,
  6. Peter Lange10,11,
  7. Magnus T Jensen12
  1. 1 Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Naestved, Sjaelland, Denmark
  2. 2 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
  3. 3 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
  4. 4 Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
  5. 5 Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
  6. 6 Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
  7. 7 Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  8. 8 The National Institute of Public Health, University of Southern Denmark, Odense, Denmark
  9. 9 The Danish Heart Foundation, Copenhagen, Denmark
  10. 10 Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  11. 11 Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
  12. 12 William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University of London, Charterhouse Square Campus, London, UK
  1. Correspondence to Dr Daniel B Rasmussen, Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, 4700 Naestved, Sjaelland, Denmark; daniel.rasmussen{at}live.dk

Abstract

Introduction Patients with chronic obstructive pulmonary disease (COPD) are undertreated with beta-blockers following myocardial infarction (MI), possibly due to fear for acute exacerbations of COPD (AECOPD). Is beta-blocker use associated with increased risk of AECOPD in patients following first-time MI?

Methods Danish nationwide study of patients with COPD following hospitalisation for MI from 2003 to 2015. Multivariable, time-dependent Cox regression accounting for varying beta-blocker use based on claimed prescriptions during up to 13 years of follow-up.

Results A total of 10 884 patients with COPD were discharged after first-time MI. The 1-year rate of AECOPD was 35%, and 65% used beta-blockers at 1 year. Beta-blocker use was associated with a lower risk of AECOPD (multivariable-adjusted HR 0.78, 95% CI 0.74–0.83). This association was independent of the type of MI (HR 0.70, 95% CI 0.59–0.83 in ST-elevation MI (STEMI) and HR 0.80, 95% CI 0.75–0.84 in non-STEMI), presence or absence of heart failure (HR 0.82, 95% CI 0.74–0.90 and HR 0.77, 95% CI 0.72–0.82, respectively), beta-blocker dosage and type, as well as exacerbation severity. Results were similar in 1118 patients with full data on COPD severity and symptom burden (median forced expiratory volume in 1 s as percentage of predicted was 46 and majority had moderate dyspnoea), and in 1358 patients with severe COPD and frequent AECOPD with a high 1-year rate of AECOPD of 70%.

Discussion Beta-blocker use was not associated with increased risk of AECOPD following MI. This finding was independent of COPD severity, symptom burden and exacerbation history, and supports the safety of beta-blockers in patients with COPD, including high-risk patients with severe disease.

  • COPD exacerbations
  • COPD epidemiology
  • COPD pharmacology

https://doi.org/10.1136/thoraxjnl-2019-214206

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    Footnotes

    • Contributors DBR, MTJ, UB, ML and PL conceptualised and designed the study. Statistical analyses were done by DBR with assistance from ML. DBR wrote the first draft of the manuscript with input from MTJ, UB, ML and PL. All authors critically revised the manuscript and approved the submitted version. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work.

    • Funding This study was funded by the University of Southern Denmark, Naestved-Slagelse-Ringsted Hospitals, and The Health Foundation (grant #15-B-0234).

    • Competing interests CT-P reports grants from Bayer, grants from Novo Nordisk, outside the submitted work.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. Anonymized data from national health registers.