Effectiveness of Beta-Blockers in COPD and Cardiovascular Disease: Real-World Effects on Mortality

Although beta-blockers are effective at reducing mortality in certain cardiovascular diseases (CVDs), their effectiveness in patients with COPD and CVD is uncertain, particularly with the concurrent use of long-acting beta₂-agonists (LABAs).

Is the initiation of beta-blockers in patients with COPD and CVD associated with reduced mortality, and is this effect influenced by concurrent use of LABAs?

The United Kingdom's Clinical Practice Research Datalink (CPRD) Aurum network was used to form a cohort of patients with COPD and CVD from January 2002 to March 2021 who were aged ≥ 40 years. A prevalent new-user design, conceived to emulate a trial, was used, matching initiators of beta-blockers with nonusers on time and propensity score as well as CVD indication, namely heart failure (HF), ischemic heart disease (IHD), atrial fibrillation, and hypertension. Hazard ratios (HRs) and 95% CIs of all-cause mortality were estimated by using an as-treated approach.

The study cohort included 11,594 initiators of beta-blockers and 11,594 matched nonusers. The HR of death with beta-blocker use relative to nonuse was 0.88 (95% CI, 0.81-0.95). The HR was 0.95 (95% CI, 0.85-1.05) among concurrent LABA users and 0.80 (95% CI, 0.71-0.91) among LABA nonusers (P_interaction = .04), an effect driven by patients with IHD (P_interaction = .01). The HR was 0.77 (95% CI, 0.66-0.89) among patients with HF, 0.84 (95% CI, 0.73-0.98) for IHD, 0.96 (95% CI, 0.83-1.11) for atrial fibrillation, and 1.10 (95% CI, 0.87-1.38) for hypertension.

This large population-based study, designed to emulate a trial, suggests that beta-blocker use is effective at reducing all-cause mortality in patients with COPD and CVD but only in those with HF or IHD, not in those with atrial fibrillation or hypertension. The concurrent use of LABAs could mitigate the effectiveness of beta-blockers at reducing mortality.