Key result
Beta-blocker use in high-risk COPD outpatients was associated with increased all-cause mortality (HR 1.37; 95% CI 0.99-1.89; p=0.059), but not with risk of AECOPD.
Why the study?
Beta-blockers have been proposed to improve COPD-related outcomes, but previous studies have reported conflicting results.
Does beta-blocker use reduce time-to-first exacerbation and all-cause mortality in high-risk COPD outpatients?
Cohort
No
Does beta-blocker use reduce time-to-first exacerbation and all-cause mortality in high-risk COPD outpatients?
Hazard Ratio: 1.37 (95% CI 0.99–1.89)
p-value: p=0.059
In high-risk COPD outpatients, beta-blocker use was associated with a borderline significant increase in all-cause mortality and did not reduce the risk of acute exacerbations.
May warrant caution with beta-blockers in high-risk COPD; leaves open causality and need for RCTs.
Background: Beta-blockers have been proposed to improve COPD-related outcomes, yet studies report conflicting results. We aimed to investigate the effect of beta blockers on time-to-first exacerbation and all-cause mortality in high-risk COPD outpatients. Methods: All COPD outpatients managed at the Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Denmark in 2016 were followed for 3.5 years in this retrospective, registry-based cohort study. Outcomes were time-to-first acute exacerbation of COPD (AECOPD) or death. The association was estimated using time-varying crude and multivariable Cox proportional hazard regression adjusted for age, sex, BMI, use of COPD medication, smoking status, cardiovascular disease and COPD severity. Results: 44% predicted (IQR 33%; 57%). The annual exacerbation rate was 0.88 (SD 1.68) and 211 patients (22%) had a history of hospitalization requiring AECOPD within 12 months. Of the enrolled patients, 247 (26%) were prescribed beta blockers. Beta-blocker use was associated, although with borderline significance, with increased all-cause mortality (HR 1.37 (95% CI, 0.99 to 1.89, p = 0.059)). On the other hand, beta blocker use did not reduce the risk of AECOPD (HR = 0.89 (95% CI 0.71 to 1.10; p = 0.270)), which remained non-significant after stratifying for severity of exacerbations. Conclusion: We found an association between beta blocker use and all-cause mortality in high-risk COPD outpatients. No association was found between beta blocker use and risk of AECOPD.
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Damkjær et al. (2021) conducted a cohort in Chronic Obstructive Pulmonary Disease (COPD). Beta-blockers vs. No beta-blockers was evaluated on all-cause mortality (HR 1.37, 95% CI 0.99-1.89, p=0.059). Beta-blocker use in high-risk COPD outpatients was associated with increased all-cause mortality (HR 1.37; 95% CI 0.99-1.89; p=0.059), but not with risk of AECOPD.
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