Starting β blockers during hospital admission for a first myocardial infarction in patients with COPD was associated with improved survival (HR 0.50; 95% CI 0.36-0.69; P<0.001).
Cohort (n=1,063)
Yes
Does beta blocker therapy improve survival in adults with COPD after a first myocardial infarction?
Beta-blocker use in COPD patients after a first myocardial infarction is associated with significantly improved survival, supporting their use in this often-undertreated comorbidity subgroup.
Hazard Ratio: 0.5 (95% CI 0.36–0.69)
p-value: p=<0.001
OBJECTIVES: To investigate whether the use and timing of prescription of β blockers in patients with chronic obstructive pulmonary disease (COPD) having a first myocardial infarction was associated with survival and to identify factors related to their use. DESIGN: Population based cohort study in England. SETTING: UK national registry of myocardial infarction (Myocardial Ischaemia National Audit Project (MINAP)) linked to the General Practice Research Database (GPRD), 2003-11. PARTICIPANTS: Patients with COPD with a first myocardial infarction in 1 January 2003 to 31 December 2008 as recorded in MINAP, who had no previous evidence of myocardial infarction in their GPRD or MINAP record. Data were provided by the Cardiovascular Disease Research using Linked Bespoke studies and Electronic Health Records (CALIBER) group at University College London. MAIN OUTCOME MEASURE: Cox proportional hazards ratio for mortality after myocardial infarction in patients with COPD in those prescribed β blockers or not, corrected for covariates including age, sex, smoking status, drugs, comorbidities, type of myocardial infarction, and severity of infarct. RESULTS: Among 1063 patients with COPD, treatment with β blockers started during the hospital admission for myocardial infarction was associated with substantial survival benefits (fully adjusted hazard ratio 0.50, 95% confidence interval 0.36 to 0.69; P<0.001; median follow-up time 2.9 years). Patients already taking a β blocker before their myocardial infarction also had a survival benefit (0.59, 0.44 to 0.79; P<0.001). Similar results were obtained with propensity scores as an alternative method to adjust for differences between those prescribed and not prescribed β blockers. With follow-up started from date of discharge from hospital, the effect size was slightly attenuated but there was a similar protective effect of treatment with β blockers started during hospital admission for myocardial infarction (0.64, 0.44 to 0.94; P=0.02). CONCLUSIONS: The use of β blockers started either at the time of hospital admission for myocardial infarction or before a myocardial infarction is associated with improved survival after myocardial infarction in patients with COPD. REGISTRATION: NCT01335672.
Quint et al. (Fri,) conducted a cohort in COPD with a first myocardial infarction (n=1,063). β blockers vs. Not prescribed β blockers was evaluated on Mortality after myocardial infarction (HR 0.50, 95% CI 0.36 to 0.69, p=<0.001). Starting β blockers during hospital admission for a first myocardial infarction in patients with COPD was associated with improved survival (HR 0.50; 95% CI 0.36-0.69; P<0.001).
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