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

Brian Lipworth, Derek Skinner, Graham Devereux, Victoria Thomas, Joanna Ling Zhi Jie, Jessica Martin, Victoria Carter, David B Price

Research output: Contribution to journalArticle

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Abstract

Objective Although β-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 β-blockers. We wished to assess the real-life use of β-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 β-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 β-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 β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-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 β-blockers more often for concomitant HF.
Original languageEnglish
Pages (from-to)1909-1914
Number of pages6
JournalHeart
Volume102
Issue number23
Early online date5 Jul 2016
DOIs
Publication statusPublished - Dec 2016

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Chronic Obstructive Pulmonary Disease
Heart Failure
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Adrenal Cortex Hormones
Muscarinic Antagonists
Bronchoconstriction
Nebulizers and Vaporizers
Patient Care
Myocardial Infarction
Databases
Guidelines
Therapeutics

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Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease. / Lipworth, Brian; Skinner, Derek; Devereux, Graham; Thomas, Victoria; Zhi Jie, Joanna Ling ; Martin, Jessica; Carter, Victoria; Price, David B.

In: Heart, Vol. 102, No. 23, 12.2016, p. 1909-1914.

Research output: Contribution to journalArticle

Lipworth, B, Skinner, D, Devereux, G, Thomas, V, Zhi Jie, JL, Martin, J, Carter, V & Price, DB 2016, 'Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease' Heart, vol. 102, no. 23, pp. 1909-1914. https://doi.org/10.1136/heartjnl-2016-309458
Lipworth, Brian ; Skinner, Derek ; Devereux, Graham ; Thomas, Victoria ; Zhi Jie, Joanna Ling ; Martin, Jessica ; Carter, Victoria ; Price, David B. / Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease. In: Heart. 2016 ; Vol. 102, No. 23. pp. 1909-1914.
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abstract = "Objective Although β-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 β-blockers. We wished to assess the real-life use of β-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 β-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 β-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 β-agonist (LABA) and long-acting muscarinic antagonist, 27{\%} of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46{\%} taking an ACEI/ARB without β-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 β-blockers more often for concomitant HF.",
author = "Brian Lipworth and Derek Skinner and Graham Devereux and Victoria Thomas and {Zhi Jie}, {Joanna Ling} and Jessica Martin and Victoria Carter and Price, {David B}",
note = "Acknowledgments The data in this article have been partly presented in preliminary abstract form as a poster at the winter meeting of the British Thoracic Society, London, 2 December 2015 (10.1136/thoraxjnl-2015-207770.161).",
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T1 - Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease

AU - Lipworth, Brian

AU - Skinner, Derek

AU - Devereux, Graham

AU - Thomas, Victoria

AU - Zhi Jie, Joanna Ling

AU - Martin, Jessica

AU - Carter, Victoria

AU - Price, David B

N1 - Acknowledgments The data in this article have been partly presented in preliminary abstract form as a poster at the winter meeting of the British Thoracic Society, London, 2 December 2015 (10.1136/thoraxjnl-2015-207770.161).

PY - 2016/12

Y1 - 2016/12

N2 - Objective Although β-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 β-blockers. We wished to assess the real-life use of β-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 β-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 β-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 β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-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 β-blockers more often for concomitant HF.

AB - Objective Although β-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 β-blockers. We wished to assess the real-life use of β-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 β-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 β-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 β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-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 β-blockers more often for concomitant HF.

U2 - 10.1136/heartjnl-2016-309458

DO - 10.1136/heartjnl-2016-309458

M3 - Article

VL - 102

SP - 1909

EP - 1914

JO - Heart

JF - Heart

SN - 1355-6037

IS - 23

ER -