Beta-blocker use and acute exacerbations of COPD following myocardial infarction: a Danish nationwide cohort study
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Beta-blocker use and acute exacerbations of COPD following myocardial infarction : a Danish nationwide cohort study. / Rasmussen, Daniel B; Bodtger, Uffe; Lamberts, Morten; Torp-Pedersen, Christian; Gislason, Gunnar; Lange, Peter; Jensen, Magnus T.
I: Thorax, Bind 75, Nr. 11, 2020, s. 928-933.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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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
Y1 - 2020
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 - Acute Disease
KW - Adrenergic beta-Antagonists/therapeutic use
KW - Aged
KW - Aged, 80 and over
KW - Denmark
KW - Disease Progression
KW - Female
KW - Humans
KW - Male
KW - Myocardial Infarction/drug therapy
KW - Pulmonary Disease, Chronic Obstructive/drug therapy
KW - Registries
KW - Risk Factors
U2 - 10.1136/thoraxjnl-2019-214206
DO - 10.1136/thoraxjnl-2019-214206
M3 - Journal article
C2 - 32820080
VL - 75
SP - 928
EP - 933
JO - Thorax
JF - Thorax
SN - 0040-6376
IS - 11
ER -
ID: 260764593