Underuse of [beta]-blockers in heart failure and chronic obstructive pulmonary disease
Objective Although β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-bl...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2016-12, Vol.102 (23), p.1909 |
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| creator | Lipworth, Brian Skinner, Derek Devereux, Graham Thomas, Victoria Ling Zhi Jie, Joanna Martin, Jessica Carter, Victoria Price, David B |
| description | Objective Although β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-blockers for patients with HF and comorbid COPD. Methods We evaluated data from the Optimum Patient Care Research Database over a period of 1 year for co-prescribing of β-blockers with either an ACE inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) in patients with HF alone versus HF+COPD. Association with inhaler therapy was also evaluated. Results We identified 89 861 patients with COPD, 24 237 with HF and 10 853 with both conditions. In patients with HF+COPD, the mean age was 79 years; 60% were male, and 27% had prior myocardial infarction. Of patients with HF+COPD, 22% were taking a β-blocker in conjunction with either ACEI/ARB (n=2416) compared with 41% of patients with HF only (n=10 002) (adjusted OR 0.54, 95% CI 0.51 to 0.58, p |
| doi_str_mv | 10.1136/heartjnl-2016-309458 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest</sourceid><recordid>TN_cdi_proquest_journals_1845230703</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4267629441</sourcerecordid><originalsourceid>FETCH-proquest_journals_18452307033</originalsourceid><addsrcrecordid>eNqNjE1KBDEQhYMoOP7cwEWB62hl0p3pWYviAVQEkSHdXc2kjclYlQje3lE8gKv3-N7HU-rC4JUx1l1vyXOZU9RLNE5bXDdtd6AWpnHdD3o-3HfbttqhXR2rE5EZEZt15xbq6TGNxFUI8gQvPRX_qvuYhzdigZDg9xomH2JlAp9GGLacUxgg91K4DiV8EuxqfM_J8xeMQcgLnamjyUeh8788VZd3tw8393rH-aOSlM2cK6f9tDFd0y4trtDa_1nfJpxKgg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1845230703</pqid></control><display><type>article</type><title>Underuse of [beta]-blockers in heart failure and chronic obstructive pulmonary disease</title><source>BMJ Journals - NESLi2</source><source>PubMed Central</source><creator>Lipworth, Brian ; Skinner, Derek ; Devereux, Graham ; Thomas, Victoria ; Ling Zhi Jie, Joanna ; Martin, Jessica ; Carter, Victoria ; Price, David B</creator><creatorcontrib>Lipworth, Brian ; Skinner, Derek ; Devereux, Graham ; Thomas, Victoria ; Ling Zhi Jie, Joanna ; Martin, Jessica ; Carter, Victoria ; Price, David B</creatorcontrib><description>Objective Although β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-blockers for patients with HF and comorbid COPD. Methods We evaluated data from the Optimum Patient Care Research Database over a period of 1 year for co-prescribing of β-blockers with either an ACE inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) in patients with HF alone versus HF+COPD. Association with inhaler therapy was also evaluated. Results We identified 89 861 patients with COPD, 24 237 with HF and 10 853 with both conditions. In patients with HF+COPD, the mean age was 79 years; 60% were male, and 27% had prior myocardial infarction. Of patients with HF+COPD, 22% were taking a β-blocker in conjunction with either ACEI/ARB (n=2416) compared with 41% of patients with HF only (n=10 002) (adjusted OR 0.54, 95% CI 0.51 to 0.58, p<0.001). Among HF+COPD patients taking inhaled corticosteroid (ICS) with long-acting β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-blockers (n=1316). Corresponding figures for those patients taking ICS/LABA were 20% (n=583) versus 48% (n=1367), respectively. Conclusions These data indicate a substantial unmet need for patients with COPD who should be prescribed β-blockers more often for concomitant HF.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2016-309458</identifier><language>eng</language><publisher>London: BMJ Publishing Group LTD</publisher><subject>Asthma ; Body mass index ; Cardiovascular disease ; Chronic obstructive pulmonary disease ; Heart failure ; Inhalers ; Mortality ; Patients</subject><ispartof>Heart (British Cardiac Society), 2016-12, Vol.102 (23), p.1909</ispartof><rights>Copyright: 2016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27906,27907</link.rule.ids></links><search><creatorcontrib>Lipworth, Brian</creatorcontrib><creatorcontrib>Skinner, Derek</creatorcontrib><creatorcontrib>Devereux, Graham</creatorcontrib><creatorcontrib>Thomas, Victoria</creatorcontrib><creatorcontrib>Ling Zhi Jie, Joanna</creatorcontrib><creatorcontrib>Martin, Jessica</creatorcontrib><creatorcontrib>Carter, Victoria</creatorcontrib><creatorcontrib>Price, David B</creatorcontrib><title>Underuse of [beta]-blockers in heart failure and chronic obstructive pulmonary disease</title><title>Heart (British Cardiac Society)</title><description>Objective Although β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-blockers for patients with HF and comorbid COPD. Methods We evaluated data from the Optimum Patient Care Research Database over a period of 1 year for co-prescribing of β-blockers with either an ACE inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) in patients with HF alone versus HF+COPD. Association with inhaler therapy was also evaluated. Results We identified 89 861 patients with COPD, 24 237 with HF and 10 853 with both conditions. In patients with HF+COPD, the mean age was 79 years; 60% were male, and 27% had prior myocardial infarction. Of patients with HF+COPD, 22% were taking a β-blocker in conjunction with either ACEI/ARB (n=2416) compared with 41% of patients with HF only (n=10 002) (adjusted OR 0.54, 95% CI 0.51 to 0.58, p<0.001). Among HF+COPD patients taking inhaled corticosteroid (ICS) with long-acting β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-blockers (n=1316). Corresponding figures for those patients taking ICS/LABA were 20% (n=583) versus 48% (n=1367), respectively. Conclusions These data indicate a substantial unmet need for patients with COPD who should be prescribed β-blockers more often for concomitant HF.</description><subject>Asthma</subject><subject>Body mass index</subject><subject>Cardiovascular disease</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Heart failure</subject><subject>Inhalers</subject><subject>Mortality</subject><subject>Patients</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNjE1KBDEQhYMoOP7cwEWB62hl0p3pWYviAVQEkSHdXc2kjclYlQje3lE8gKv3-N7HU-rC4JUx1l1vyXOZU9RLNE5bXDdtd6AWpnHdD3o-3HfbttqhXR2rE5EZEZt15xbq6TGNxFUI8gQvPRX_qvuYhzdigZDg9xomH2JlAp9GGLacUxgg91K4DiV8EuxqfM_J8xeMQcgLnamjyUeh8788VZd3tw8393rH-aOSlM2cK6f9tDFd0y4trtDa_1nfJpxKgg</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Lipworth, Brian</creator><creator>Skinner, Derek</creator><creator>Devereux, Graham</creator><creator>Thomas, Victoria</creator><creator>Ling Zhi Jie, Joanna</creator><creator>Martin, Jessica</creator><creator>Carter, Victoria</creator><creator>Price, David B</creator><general>BMJ Publishing Group LTD</general><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>20161201</creationdate><title>Underuse of [beta]-blockers in heart failure and chronic obstructive pulmonary disease</title><author>Lipworth, Brian ; Skinner, Derek ; Devereux, Graham ; Thomas, Victoria ; Ling Zhi Jie, Joanna ; Martin, Jessica ; Carter, Victoria ; Price, David B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-proquest_journals_18452307033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Asthma</topic><topic>Body mass index</topic><topic>Cardiovascular disease</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Heart failure</topic><topic>Inhalers</topic><topic>Mortality</topic><topic>Patients</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lipworth, Brian</creatorcontrib><creatorcontrib>Skinner, Derek</creatorcontrib><creatorcontrib>Devereux, Graham</creatorcontrib><creatorcontrib>Thomas, Victoria</creatorcontrib><creatorcontrib>Ling Zhi Jie, Joanna</creatorcontrib><creatorcontrib>Martin, Jessica</creatorcontrib><creatorcontrib>Carter, Victoria</creatorcontrib><creatorcontrib>Price, David B</creatorcontrib><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lipworth, Brian</au><au>Skinner, Derek</au><au>Devereux, Graham</au><au>Thomas, Victoria</au><au>Ling Zhi Jie, Joanna</au><au>Martin, Jessica</au><au>Carter, Victoria</au><au>Price, David B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Underuse of [beta]-blockers in heart failure and chronic obstructive pulmonary disease</atitle><jtitle>Heart (British Cardiac Society)</jtitle><date>2016-12-01</date><risdate>2016</risdate><volume>102</volume><issue>23</issue><spage>1909</spage><pages>1909-</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>Objective Although β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-blockers for patients with HF and comorbid COPD. Methods We evaluated data from the Optimum Patient Care Research Database over a period of 1 year for co-prescribing of β-blockers with either an ACE inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) in patients with HF alone versus HF+COPD. Association with inhaler therapy was also evaluated. Results We identified 89 861 patients with COPD, 24 237 with HF and 10 853 with both conditions. In patients with HF+COPD, the mean age was 79 years; 60% were male, and 27% had prior myocardial infarction. Of patients with HF+COPD, 22% were taking a β-blocker in conjunction with either ACEI/ARB (n=2416) compared with 41% of patients with HF only (n=10 002) (adjusted OR 0.54, 95% CI 0.51 to 0.58, p<0.001). Among HF+COPD patients taking inhaled corticosteroid (ICS) with long-acting β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-blockers (n=1316). Corresponding figures for those patients taking ICS/LABA were 20% (n=583) versus 48% (n=1367), respectively. Conclusions These data indicate a substantial unmet need for patients with COPD who should be prescribed β-blockers more often for concomitant HF.</abstract><cop>London</cop><pub>BMJ Publishing Group LTD</pub><doi>10.1136/heartjnl-2016-309458</doi></addata></record> |
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| source | BMJ Journals - NESLi2; PubMed Central |
| subjects | Asthma Body mass index Cardiovascular disease Chronic obstructive pulmonary disease Heart failure Inhalers Mortality Patients |
| title | Underuse of [beta]-blockers in heart failure and chronic obstructive pulmonary disease |
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