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Beta-blocker under-use in COPD patients
Kuan Pin Lim1,2, Sarah Loughrey1, Michael Musk1,2
1Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia.
Insights
Beta-blockers (BBs) are under-prescribed in patients hospitalized with chronic obstructive pulmonary disease (COPD) exacerbations, despite evidence of benefit. This underuse may contribute to cardiovascular complications and poorer patient outcomes.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Clinical Pharmacy
Background:
- Cardiovascular (CVS) comorbidities are prevalent in patients with chronic obstructive pulmonary disease (COPD) and significantly increase morbidity and mortality, particularly after acute exacerbations (AECOPD).
- Beta-blockers (BBs) are established as safe and effective for COPD patients, offering a survival advantage post-myocardial infarction.
- Underutilization of BBs in hospitalized AECOPD patients and the incidence/impact of CVS and cerebrovascular complications warrant investigation.
Purpose of the Study:
- To evaluate the prescribing patterns of BBs in hospitalized patients diagnosed with AECOPD.
- To determine the rates of inpatient CVS and cerebrovascular complications in this patient cohort.
- To assess the association between BB use and patient outcomes, including length of stay and mortality.
Main Methods:
- A retrospective analysis of hospital data was conducted over a 12-month period.
- Medical records of patients over 40 years old with an AECOPD diagnosis were reviewed.
- Prevalent BB use, incident BB initiation, and relevant comorbidities (indications/contraindications) were assessed.
Main Results:
- Of 366 eligible patients, 42.6% had an indication for BBs, yet only 34.0% were prescribed BBs, and 39.1% had no contraindication but were not on therapy.
- Prevalent BB use (19.7%) was lower than that of anti-platelets (45.6%), statins (39.6%), and ACEI/ARBs (45.9%).
- CVS and cerebrovascular complications occurred in 16% of patients, correlating with longer hospital stays (p<0.01) and increased inpatient mortality (p=0.02).
Conclusions:
- Beta-blockers are significantly under-prescribed in COPD patients with clear indications for their use.
- Further research is necessary to identify and address the barriers to BB prescribing in this vulnerable population.
- Optimizing BB use in AECOPD patients could potentially reduce cardiovascular complications and improve clinical outcomes.
Background:
Cardiovascular (CVS) comorbidities are common in COPD and contribute significantly to morbidity and mortality, especially following acute exacerbations of COPD (AECOPD). Beta-blockers (BBs) are safe and effective in COPD patients, with demonstrated survival benefit following myocardial infarction. We sought to determine if BBs are under-prescribed in patients hospitalized with AECOPD. We also sought to determine inpatient rates of CVS and cerebrovascular complications, and their impact on patient outcomes.
Methods:
Retrospective hospital data was collected over a 12-month period. The medical records of all patients >40 years of age coded with a diagnosis of AECOPD were analyzed. Prevalent use and incident initiation of BBs were assessed. Comorbidities including indications and contraindications for BB use were analyzed.
Results:
Of the 366 eligible patients, 156 patients (42.6%) had at least one indication for BB use - of these patients, only 53 (34.0%) were on BB therapy and 61 (39.1%) were not on BB therapy but had no listed contraindication. Prevalent use of BBs at the time of admission in all 366 patients was 19.7%, compared with 45.6%, 39.6% and 45.9% use of anti-platelets, statins and angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers, respectively. CVS and cerebrovascular complications were common in this population (57 patients, 16%) and were associated with longer length of stay (p<0.01) and greater inpatient mortality (p=0.02).
Conclusions:
BBs are under-prescribed in COPD patients despite clear indication(s) for their use. Further work is required to explore barriers to BB prescribing in COPD patients.
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