Key result
Beta-blockers linked to ~26% lower CV death or HHF in HFrEF with COPD.
Why the study?
Patients with HFrEF and COPD are poorly represented in HFrEF trials testing beta-blockers, creating uncertainty about cardiovascular effectiveness and respiratory safety in this population.
Does beta-blocker use reduce the risk of cardiovascular events without increasing severe COPD exacerbations in patients with HFrEF and concomitant COPD?
Observational (n=5,084)
Yes
Does beta-blocker use reduce the risk of cardiovascular events without increasing severe COPD exacerbations in patients with HFrEF and concomitant COPD?
In patients with HFrEF and concomitant COPD, beta-blocker therapy improves cardiovascular outcomes without increasing the risk of severe COPD exacerbations, supporting their safety and efficacy in this underrepresented group.
Supports beta-blocker consideration in HFrEF-COPD; leaves open confirmation by randomized trials.
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.
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Beer et al. (2025) conducted an observational in Heart failure with reduced ejection fraction and chronic obstructive pulmonary disease (n=5,084). Beta-blockers vs. Non-users of beta-blockers was evaluated on Composite of cardiovascular death and total number of hospitalizations for heart failure (RR 0.74, 95% CI 0.58-0.96). Beta-blocker use in patients with HFrEF and COPD was associated with a lower risk of cardiovascular death or heart failure hospitalizations (RR 0.74) without increasing severe COPD exacerbations.
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