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Heart failure and cardiomyopathies
Original article
Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease
  1. Brian Lipworth1,
  2. Derek Skinner2,
  3. Graham Devereux3,
  4. Victoria Thomas4,
  5. Joanna Ling Zhi Jie5,
  6. Jessica Martin6,
  7. Victoria Carter2,
  8. David B Price5,7
  1. 1Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
  2. 2Optimum Patient Care, Cambridge, UK
  3. 3Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  4. 4Cambridge Research Support, Cambridge, UK
  5. 5Observational and Pragmatic Research Institute, Singapore, Singapore
  6. 6Research in Real Life, Cambridge, UK
  7. 7Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Brian Lipworth, Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK; b.j.lipworth{at}dundee.ac.uk

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.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/heartjnl-2016-309458

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    Footnotes

    • Contributors BL had the original idea and wrote the initial draft of the manuscript. DBP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. DS, GD, VT, JL, JM and VC contributed substantially to the study design, data analysis and interpretation and the writing of the manuscript. The data were provided through the Respiratory Effectiveness Group.

    • Competing interests BL reports grants and personal fees from Chiesi, personal fees from Boerhingher Ingelheim, grants and personal fees from Meda, grants and personal fees from Teva, grants from Janssen, grants from AstraZeneca, grants from Roche, outside the submitted work; VT reports other from Cambridge Research Support, outside the submitted work; JL reports other from Observational and Pragmatic Research Institute, during the conduct of the study; JM reports other from Research in Real Life, outside the submitted work; DBP has board membership with Aerocrine, Almirall, Amgen, AstraZeneca plc, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis International AG and Teva. Consultancy: A Almirall, Amgen, AstraZeneca plc, Boehringer Ingelheim, Chiesi, GlaxoSmithKline plc, Meda, Mundipharma, Napp, Novartis International AG, Pfizer and Teva; Grants and unrestricted funding for investigator-initiated studies from UK National Health Service, British Lung Foundation, Aerocrine, AKL, Almirall, AstraZeneca plc, Boehringer Ingelheim, Chiesi, Eli Lilly, GlaxoSmithKline plc, Meda, Merck & Co., Mundipharma, Napp, Novartis International AG, Orion, Pfizer, Respiratory Effectiveness Group, Takeda, Teva and Zentiva; Payments for lectures/speaking: Almirall, AstraZeneca plc, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline plc, Kyorin, Meda, Merck & Co., Mundipharma, Novartis International AG, Pfizer, SkyePharma, Takeda and Teva; Payment for manuscript preparation: Mundipharma and Teva; Patents (planned, pending or issued): AKL; Payment for the development of educational materials: GlaxoSmithKline plc, Novartis International AG; Stock/Stock options: Shares in AKL which produces phytopharmaceuticals and owns 80% of Research in Real Life and its subsidiary social enterprise Optimum Patient Care; received payment for travel/accommodations/meeting expenses from Aerocrine, Boehringer Ingelheim, Mundipharma, Napp, Novartis International AG and Teva; Funding for patient enrolment or completion of research: Almirral, Chiesi, Teva and Zentiva; Peer reviewer for grant committees: Medical Research Council (2014), Efficacy and Mechanism Evaluation programme (2012), HTA (2014).

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

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