Key result
ICU beta-blocker therapy linked to ~33% lower 28-day mortality in patients with HF and COPD.
Why the study?
Heart failure and COPD frequently co-occur, but concerns about respiratory complications often lead to underuse of beta-blockers in this population.
Does beta-blocker therapy reduce short-term mortality in adult ICU patients with coexisting heart failure and COPD?
Cohort (n=1,386)
No
Does beta-blocker therapy reduce short-term mortality in adult ICU patients with coexisting heart failure and COPD?
Effect estimate: HR 0.667 (95% CI 0.491-0.906)
Absolute Event Rate: 17.51% vs 23.98%
p-value: p=0.021
Beta-blocker therapy during ICU admission is associated with significantly reduced short-term mortality in critically ill patients with coexisting heart failure and COPD, supporting its use despite respiratory concerns.
Supports beta-blocker use in HF-COPD ICU patients despite respiratory concerns; extends evidence to this critically ill population.
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently co-occur, complicating treatment. Concerns about respiratory complications often lead to underuse of β-blockers in this population. This study aims to assess the relationship between β-blocker use and clinical outcomes in patients with HF and COPD. This retrospective cohort study utilized the MIMIC-IV v2.2 database. Adult ICU patients with documented HF and COPD diagnoses were identified using international classification of diseases (ICD-9 and ICD-10) diagnostic codes. Propensity score matching (PSM) was applied to reduce confounding bias. Cox regression was used to estimate hazard ratios (HRs), with additional regression and doubly robust methods applied for validation. Subgroup analyses were performed to determine whether the results were consistent across different patient groups. After PSM, β-blocker use was associated with a significantly lower 28-day mortality rate (17.51 vs. 23.98%, P = 0.021), with a HR of 0.667 (95% CI 0.491–0.906). Similar reductions were observed in hospital mortality (13.91 vs. 20.62%, P = 0.010), 60-day mortality (24.46 vs. 30.94%, P = 0.037), and 90-day mortality (27.58 vs. 34.77%, P = 0.025). However, β-blocker users had longer ICU and hospital stays. Subgroup analysis revealed a significant interaction between β-blocker use and mechanical ventilation, with greater mortality reduction observed in ventilated patients (HR: 0.31, 95% CI 0.17–0.56). β-blocker therapy during ICU stay was observed to be associated with improved short-term survival among patients with HF and COPD. These findings suggest that β-blockers may provide substantial survival benefits in this high-risk patient population, despite concerns regarding potential respiratory side effect.
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Wang et al. (2026) conducted a cohort in Heart failure and chronic obstructive pulmonary disease (n=1,386). β-blockers vs. No β-blockers was evaluated on 28-day mortality (HR 0.667, 95% CI 0.491-0.906, p=0.021). β-blocker therapy during ICU stay was associated with a significantly lower 28-day mortality rate (HR 0.667) compared to no β-blocker use in patients with concurrent heart failure and COPD.
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