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Beta-blocker use and acute exacerbations of COPD following myocardial infarction: a Danish nationwide cohort study

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@article{8db0877f2a544e71b91c3359efa0ad8e,
title = "Beta-blocker use and acute exacerbations of COPD following myocardial infarction: a Danish nationwide cohort study",
abstract = "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.",
keywords = "COPD epidemiology, COPD exacerbations, COPD pharmacology",
author = "Rasmussen, {Daniel B} and Uffe Bodtger and Morten Lamberts and Christian Torp-Pedersen and Gunnar Gislason and Peter Lange and Jensen, {Magnus T}",
note = "{\circledC} Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2020",
month = "11",
doi = "10.1136/thoraxjnl-2019-214206",
language = "English",
volume = "75",
pages = "928--933",
journal = "Thorax",
issn = "0040-6376",
publisher = "B M J Group",
number = "11",

}

RIS

TY - JOUR

T1 - Beta-blocker use and acute exacerbations of COPD following myocardial infarction

T2 - a Danish nationwide cohort study

AU - Rasmussen, Daniel B

AU - Bodtger, Uffe

AU - Lamberts, Morten

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

AU - Lange, Peter

AU - Jensen, Magnus T

N1 - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2020/11

Y1 - 2020/11

N2 - 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.

AB - 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.

KW - COPD epidemiology

KW - COPD exacerbations

KW - COPD pharmacology

UR - http://www.scopus.com/inward/record.url?scp=85093705909&partnerID=8YFLogxK

U2 - 10.1136/thoraxjnl-2019-214206

DO - 10.1136/thoraxjnl-2019-214206

M3 - Journal article

VL - 75

SP - 928

EP - 933

JO - Thorax

JF - Thorax

SN - 0040-6376

IS - 11

ER -

ID: 61014520