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ARTICLE CONTRIBUTORS

Journal of the American Heart Association

Clinical Articles, Lead Article

β-blockers safe in post-MI patients with COPD?

Despite earlier concerns of possible harmful effects, it has now been shown that patients with chronic obstructive pulmonary disorder (COPD) discharged with β‐blockers after a myocardial infarction (MI) had a lower all‐cause mortality compared to patients not prescribed β‐blockers, according to a study published recently in the Journal of the American Heart Association.1

Patients hospitalised for MI between 2005 and 2010 were identified from the nationwide Swedish registry SWEDEHEART (Swedish Health Care Registry on Heart Disease). Patients with COPD who were alive and discharged after an MI were selected as the study population. In this cohort, patients who were discharged with β‐blockers were compared to patients not discharged with β‐blockers.

The primary end point was all‐cause mortality. A total of 4,858 patients were included, of which 4086 (84.1%) were discharged with a β‐blocker while 772 (15.9%) were not. After adjusting for potential confounders including baseline characteristics, comorbidities, and in‐hospital characteristics, patients discharged with a β‐blocker had lower all‐cause mortality (hazard ratio 0.87, 95% CI 0.78 to 0.98) during the total follow‐up time (maximum 7.2 years). In the subgroup of patients with a history of heart failure, the corresponding hazard ratio was 0.77 (95% CI 0.63 to 0.95).

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Dr Pontus Andell (Skane University Hospital, Sweden)

Speaking to BJC Arrhythmia Watch, co-author Dr Pontus Andell (Skane University Hospital, Sweden) said: “As of now, the current post-MI guidelines are of course very general and do not mention COPD patients specifically. The large randomised trials that lay the foundation for guidelines in many cases employ a very selected patient population, often without complicating comorbidities. This is where real-world data from large observational studies can help investigate the effect of certain drugs in comorbid subgroups, with some inherent limitations to observational studies kept in mind.”

He continued: “As with any drug prescribed to a patient, doctors need to carefully review pros and cons when treating patients with an indication for a beta-blocker. With that said, I believe the current evidence in regard to cardioselective beta-blockers post-MI states that these drugs should be prescribed to patients with COPD. However, if a patient suffers adverse effects the treating physician should of course review the indication given the new situation”.

“I believe the beneficial association has come to light recently because we’ve started to ask ourselves and question why some patient populations receive a more conservative treatment approach, which COPD patients definitely have been subject to in the past, and the evidence seems to favour treating these patients in the same way as patients without COPD. If we realize this, and put it into practice, I believe COPD patients post-MI will benefit,” Dr Andell concluded.

References

1. β-blocker use and mortality in COPD patients after myocardial infarction: a Swedish nationwide observational study. J Am Heart Assoc 2015;4:e001611. http://dx.doi.org/10.1161/JAHA.114.001611

Published on: April 29, 2015

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