Beta-blockers in patients with heart failure with reduced ejection fraction and concomitant chronic obstructive pulmonary disease: Cardiovascular and respiratory outcomes.
Benedikt N Beer,Lina Benson,Christian Basile,Benedikt Schrage,Peter Moritz Becher,Stefan Blankenberg,Paulus Kirchhof,Barna Szabó-Söderberg,Marco Metra,Anne Lindberg,Egidio Imbalzano,Giuseppe M C Rosano,Patric Karlström,Peter G M Mol,Raffaele Scorza,Lars H Lund,Felix Lindberg,Gianluigi Savarese
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引用次数: 0
Abstract
AIMS
Patients with heart failure (HF) with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) are poorly represented in HFrEF trials testing beta-blockers. We assessed cardiovascular effectiveness and respiratory safety of beta-blockers in these patients.
METHODS AND RESULTS
Patients with HFrEF and COPD in the Swedish HF Registry (2006-2023) were included. Overlap-weighted models were used to assess associations between beta-blocker use and 5-year risk of outcomes, with cardiovascular death/total hospitalizations for HF (HHF) representing the primary cardiovascular effectiveness outcome, and total severe COPD exacerbations being the primary respiratory safety outcome. Of 5084 patients with HFrEF and COPD, median age was 75 years (interquartile range [IQR] 69-81), 68.3% were male, 36.9% were in GOLD group E, 91.5% used beta-blockers. Over a median follow-up of 2.5 years (IQR 1.0-4.8), beta-blocker users had lower crude risk of cardiovascular death/total HHF (rate ratio [RR] 0.66, 95% confidence interval [CI] 0.56-0.78) and total severe COPD exacerbations (RR 0.75, 95% CI 0.60-0.93). After overlap weighting, beta-blocker use was independently associated with lower risk of cardiovascular death/total HHF (RR 0.74, 95% CI 0.58-0.96) but not total severe COPD exacerbations (RR 0.99, 95% CI 0.73-1.35). These associations were consistent across subgroups (including GOLD groups), except for the greater magnitude of the association with lower risk of cardiovascular death/total HHF in patients with left ventricular ejection fraction <30% (p for interaction = 0.004). Falsification analyses suggested no influence from residual confounding.
CONCLUSIONS
In patients with HFrEF and COPD, beta-blocker use was associated with lower risk of cardiovascular death/total HHF, without evidence of safety concerns for COPD exacerbations.
期刊介绍:
European Journal of Heart Failure is an international journal dedicated to advancing knowledge in the field of heart failure management. The journal publishes reviews and editorials aimed at improving understanding, prevention, investigation, and treatment of heart failure. It covers various disciplines such as molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, clinical sciences, social sciences, and population sciences. The journal welcomes submissions of manuscripts on basic, clinical, and population sciences, as well as original contributions on nursing, care of the elderly, primary care, health economics, and other related specialist fields. It is published monthly and has a readership that includes cardiologists, emergency room physicians, intensivists, internists, general physicians, cardiac nurses, diabetologists, epidemiologists, basic scientists focusing on cardiovascular research, and those working in rehabilitation. The journal is abstracted and indexed in various databases such as Academic Search, Embase, MEDLINE/PubMed, and Science Citation Index.