Cardioselective beta-blocker use in COPD patients undergoing vascular surgery was associated with lower 30-day (OR 0.37; 95% CI 0.19-0.72) and long-term mortality (HR 0.73; 95% CI 0.60-0.88).
Cohort (n=3,371)
No
Does cardioselective beta-blocker use reduce 30-day and long-term mortality in patients with COPD undergoing major vascular surgery?
Cardioselective beta-blockers, particularly at intensified doses, are associated with reduced 30-day and long-term mortality in patients with COPD undergoing major vascular surgery.
Odds Ratio: 0.37 (95% CI 0.19–0.72)
RATIONALE: beta-Blocker use is associated with improved health outcomes in patients with cardiovascular disease. There is a general reluctance to prescribe beta-blockers in patients with chronic obstructive pulmonary disease (COPD) because they may worsen symptoms. OBJECTIVES: We investigated the relationship between cardioselective beta-blockers and mortality in patients with COPD undergoing major vascular surgery. METHODS: We evaluated 3,371 consecutive patients who underwent major vascular surgery at one academic institution between 1990 and 2006. The patients were divided into those with and without COPD on the basis of symptoms and spirometry. The major endpoints were 30-day and long-term mortality after vascular surgery. Patients were defined as receiving low-dose therapy if the dosage was less than 25% of the maximum recommended therapeutic dose; dosages higher than this were defined as intensified dose. MEASUREMENTS AND MAIN RESULTS: There were 1,205 (39%) patients with COPD of whom 462 (37%) received cardioselective beta-blocking agents. beta-Blocker use was associated independently with lower 30-day (odds ratio, 0.37; 95% confidence interval, 0.19-0.72) and long-term mortality in patients with COPD (hazards ratio, 0.73; 95% confidence interval, 0.60-0.88). Intensified dose was associated with both reduced 30-day and long-term mortality in patients with COPD, whereas low dose was not. CONCLUSIONS: Cardioselective beta-blockers were associated with reduced mortality in patients with COPD undergoing vascular surgery. In carefully selected patients with COPD, the use of cardioselective beta-blockers appears to be safe and associated with reduced mortality.
Gestel et al. (Thu,) conducted a cohort in Chronic Obstructive Pulmonary Disease and Atherosclerosis (n=3,371). Cardioselective beta-blockers vs. No cardioselective beta-blockers was evaluated on 30-day mortality (OR 0.37, 95% CI 0.19-0.72). Cardioselective beta-blocker use in COPD patients undergoing vascular surgery was associated with lower 30-day (OR 0.37; 95% CI 0.19-0.72) and long-term mortality (HR 0.73; 95% CI 0.60-0.88).