What does this research mean for the field?

Beta-blocker use in patients with chronic obstructive pulmonary disease and cardiovascular disease does not reduce mortality but is associated with an increased risk of emergency admissions and acute exacerbations of COPD. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aimed to evaluate the safety and effectiveness of beta-blockers in patients with both chronic obstructive pulmonary disease and cardiovascular conditions.

March 6, 2026BMC Pulmonary Medicine0 citationsOpen Access

Outcomes of beta-blocker use in people living with chronic obstructive pulmonary disease and a co-existent beta-blocker indicated cardiovascular disease. Insights from a global federated network

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Patients with chronic obstructive pulmonary disease (COPD) and co-existent cardiovascular disease including heart failure with reduced ejection fraction (HFrEF), acute myocardial infarction (AMI), and atrial fibrillation (AF) (n=394476). Intervention: Beta-blockers (BB) vs. No beta-blocker use. Primary outcome: One-year all-cause mortality (HR 0.98, 95% CI 0.94–1.02, p=0.08).

MKMert KaskalHeart Failure & Transplant TBTommaso BucciGeneral Cardiology DWDennis K. C WatUniversity of Liverpool

Key Result

Beta-blocker use did not significantly reduce one-year all-cause mortality (HR 0.98, 95% CI 0.94–1.02, p=0.08) in patients with COPD and co-existent cardiovascular disease.

Key Points

This study aimed to evaluate the safety and effectiveness of beta-blockers in patients with both chronic obstructive pulmonary disease and cardiovascular conditions.
Conducted a retrospective, propensity score–matched analysis
Utilized the TriNetX global federated research network
Included patients diagnosed with both COPD and cardiovascular diseases between January 2010 and January 2023
Assessed outcomes over a one-year follow-up, including all-cause mortality, emergency admissions, and acute exacerbations of COPD
No significant difference in all-cause mortality between beta-blocker users and non-users
Increased risk of emergency admissions associated with beta-blocker use
Modest increase in acute exacerbations of COPD for beta-blocker users
Findings were consistent across various subgroups

Study Design

Type

Observational (n=394,476)

Multicenter

Yes

Structured PICO

Does beta-blocker use improve mortality or increase exacerbations in patients with COPD and co-existing cardiovascular disease?

Population

394,476 patients with a diagnosis of both chronic obstructive pulmonary disease (COPD) and cardiovascular disease (HFrEF, AMI, or AF) between January 2010 and January 2023. Mean age 71.3-73.9 years, 44.2-46.7% female, from a global federated network.

Intervention

Beta-blockers (at least one prescription recorded during the study period)

Comparator

Non-users of beta-blockers (matched 1:1 using propensity scores for demographics, comorbidities, and medications)

Outcome

One-year all-cause mortalityhard clinical

In patients with COPD and a cardiac indication for beta-blockers, beta-blocker use did not improve 1-year mortality but was associated with increased emergency admissions and COPD exacerbations.

Main Result

Effect estimate: HR 0.98 (95% CI 0.94–1.02)

Absolute Event Rate: 5.6% vs 5.7%

p-value: p=0.08

Limitations

Retrospective observational design subject to confounding despite propensity score matching
Potential unmeasured confounders influencing emergency admissions and AECOPD outcomes
Lack of detailed dose and adherence information for beta-blockers
Generalizability limited to populations captured in the TriNetX network

Abstract

Abstract Background Beta-blockers (BBs) are a cornerstone of the management of cardiovascular diseases (CVD) such as heart failure with reduced ejection fraction (HFrEF), acute myocardial infarction (AMI), and atrial fibrillation (AF). Their use in patients with co-existing chronic obstructive pulmonary disease (COPD) remains controversial due to concerns about potential bronchoconstriction and respiratory side effects. This study aimed to assess the safety and effectiveness of BBs in patients with COPD and co-existing cardiovascular conditions using real-world data. Methods We conducted a retrospective, propensity score–matched analysis using the TriNetX global federated research network. Patients with a diagnosis of both COPD and CVD (HFrEF, AMI, or AF) between January 2010 and January 2023 were included. Outcomes assessed over a one-year follow-up included all-cause mortality (primary outcome), emergency admissions (EA), and acute exacerbations of COPD (AECOPD). Subgroup analyses were conducted based on cardiovascular indication, BB selectivity, sex, and age group. Results A total of 394,476 patients were included; 241,837 were BB users and 152,639 were non-users. After propensity score matching ( n = 103,249 per group), there was no significant difference in mortality (HR: 0.98, 95% CI: 0.94–1.02). BB use was associated with an increased risk of EA (HR: 1.30, 95% CI: 1.22–1.40) and a modest increase in AECOPD (HR: 1.03, 95% CI: 1.02–1.04). Findings were consistent across subgroups. Conclusion In people with COPD and a cardiac indication for BB use, the use of BBs was not associated with mortality benefit but was associated with a modest increased risk of AECOPD and a pronounced risk of increased EA. Clinical trial registration Not applicable. This study is not a clinical trial; therefore, no trial registry, registration number, or registration date is required. Graphical abstract

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