Key result
Beta-blocker use following first-time MI in patients with COPD was associated with a lower risk of acute exacerbations of COPD (HR 0.78; 95% CI 0.74-0.83).
Why the study?
Patients with COPD are undertreated with beta-blockers after MI, possibly due to fear of acute exacerbations of COPD.
Does beta-blocker use increase the risk of acute exacerbations of COPD in patients following first-time myocardial infarction?
Cohort (n=10,884)
Yes
Does beta-blocker use increase the risk of acute exacerbations of COPD in patients following first-time myocardial infarction?
Hazard Ratio: 0.78 (95% CI 0.74–0.83)
Beta-blocker use following myocardial infarction in patients with COPD is safe and associated with a reduced risk of acute COPD exacerbations, regardless of COPD severity or heart failure status.
May support beta-blocker continuation post-MI in COPD without AECOPD concern; leaves open causality pending randomized confirmation.
INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) are undertreated with beta-blockers following myocardial infarction (MI), possibly due to fear for acute exacerbations of COPD (AECOPD). Is beta-blocker use associated with increased risk of AECOPD in patients following first-time MI? METHODS: Danish nationwide study of patients with COPD following hospitalisation for MI from 2003 to 2015. Multivariable, time-dependent Cox regression accounting for varying beta-blocker use based on claimed prescriptions during up to 13 years of follow-up. RESULTS: A total of 10 884 patients with COPD were discharged after first-time MI. The 1-year rate of AECOPD was 35%, and 65% used beta-blockers at 1 year. Beta-blocker use was associated with a lower risk of AECOPD (multivariable-adjusted HR 0.78, 95% CI 0.74-0.83). This association was independent of the type of MI (HR 0.70, 95% CI 0.59-0.83 in ST-elevation MI (STEMI) and HR 0.80, 95% CI 0.75-0.84 in non-STEMI), presence or absence of heart failure (HR 0.82, 95% CI 0.74-0.90 and HR 0.77, 95% CI 0.72-0.82, respectively), beta-blocker dosage and type, as well as exacerbation severity. Results were similar in 1118 patients with full data on COPD severity and symptom burden (median forced expiratory volume in 1 s as percentage of predicted was 46 and majority had moderate dyspnoea), and in 1358 patients with severe COPD and frequent AECOPD with a high 1-year rate of AECOPD of 70%. DISCUSSION: Beta-blocker use was not associated with increased risk of AECOPD following MI. This finding was independent of COPD severity, symptom burden and exacerbation history, and supports the safety of beta-blockers in patients with COPD, including high-risk patients with severe disease.
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Rasmussen et al. (2020) conducted a cohort in Chronic obstructive pulmonary disease (COPD) following myocardial infarction (MI) (n=10,884). Beta-blocker use vs. No beta-blocker use was evaluated on Acute exacerbations of COPD (AECOPD) (HR 0.78, 95% CI 0.74-0.83). Beta-blocker use following first-time MI in patients with COPD was associated with a lower risk of acute exacerbations of COPD (HR 0.78; 95% CI 0.74-0.83).
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