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Improving outcomes in chronic obstructive pulmonary disease by taking beta-blockers after acute myocardial infarction: a nationwide observational study

  • Wen-Hwa Wang
  • Chin-Chang Cheng
  • Guang-Yuan Mar
  • Kai-Che Wei
  • Wei-Chun HuangEmail author
  • Chun-Peng Liu
Original Article
  • 37 Downloads

Abstract

β-Blockers are a standard therapy for acute myocardial infarction (AMI) due to their better short-term and long-term outcomes. However, β-blockers are often under-prescribed in chronic obstructive pulmonary disease (COPD) patients with AMI, since they are thought be related to bronchospasm. The aim of this study was to investigate the association between the usage of β-blockers and the risk of mortality in COPD patients after first AMI via a nationwide, population-based cohort study. In this retrospective study, we identified 186,326 patients with AMI diagnosed between January 2000 and December 2012, 23,116 of whom had COPD, from the National Health Insurance Research Database. A total of 7609 patients (32.92%) were prescribed β-blockers, while 15,507 were not. The β-blocker patients were stratified into selective and non-selective β-blocker groups. Multivariate Cox proportional hazards models were used to estimate adjusted hazard ratios (HR) with 95% confidence intervals (95% CI). Selective β-blocker use showed a reduced risk of mortality, as compared with patients without β-blockers (HR 0.93; 95% CI 0.89–0.98; p < 0.01) while non-selective β-blocker groups did not increase the risk of mortality compared to the patients without β-blockers (HR 0.98; 95% CI 0.94–1.02; p = 0.38). In addition, the use of β-blockers was found to be associated with a reduced risk of mortality in most stratified analyses which was seen particularly in males, patients aged 65 years and above, and in individuals with an array of comorbidities. These findings suggest that β-blockers improve overall survival among COPD patients after first AMI.

Keywords

β-blockers Chronic obstructive pulmonary disease Acute myocardial infarction Mortality 

Abbreviations

AMI

Acute myocardial infarction

COPD

Chronic obstructive pulmonary disease

PCI

Percutaneous coronary intervention

ACEI

Angiotensin-converting enzyme inhibitors

ARB

Angiotensin receptor blockers

SABA

Short-acting β-agonist

SAMA

Short-acting muscarinic antagonist

NHI

National Health Insurance

NHIRD

National Health Insurance Research Database

Notes

Acknowledgement

The authors are grateful to the Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, for data management and statistical analysis.

Compliance with ethical standards

Conflict of interest

All authors have declared that they have no potential conflicts (financial, professional, or personal) that are relevant to the manuscript.

Supplementary material

380_2019_1341_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 kb)

References

  1. 1.
    Rothnie KJ, Quint JK (2016) Chronic obstructive pulmonary disease and acute myocardial infarction: effects on presentation, management, and outcomes. Eur Heart J Qual Care Clin Outcomes 2:81–90CrossRefGoogle Scholar
  2. 2.
    Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R (2013) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 187:347–365CrossRefGoogle Scholar
  3. 3.
    Sin DD, Man SF (2003) Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 107:1514–1519CrossRefGoogle Scholar
  4. 4.
    Laratta CR, van Eeden S (2014) Acute exacerbation of chronic obstructive pulmonary disease: cardiovascular links. Biomed Res Int 2014:528789CrossRefGoogle Scholar
  5. 5.
    Salisbury AC, Reid KJ, Spertus JA (2007) Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes. Am J Cardiol 99:636–641CrossRefGoogle Scholar
  6. 6.
    Rothnie KJ, Yan R, Smeeth L, Quint JK (2015) Risk of myocardial infarction (MI) and death following MI in people with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. BMJ Open 5:e007824CrossRefGoogle Scholar
  7. 7.
    Misumida N, Harjai K, Kernis S, Kanei Y (2016) Does oral beta-blocker therapy improve long-term survival in ST-segment elevation myocardial infarction with preserved systolic function? A meta-analysis. J Cardiovasc Pharmacol Ther 21:280–285CrossRefGoogle Scholar
  8. 8.
    Gottlieb SS, McCarter RJ, Vogel RA (1998) Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 339:489–497CrossRefGoogle Scholar
  9. 9.
    Ni Y, Shi G, Wan H (2012) Use of cardioselective beta-blockers in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized, placebo-controlled, blinded trials. J Int Med Res 40:2051–2065CrossRefGoogle Scholar
  10. 10.
    Quint JK, Herrett E, Bhaskaran K, Timmis A, Hemingway H, Wedzicha JA, Smeeth L (2013) Effect of beta blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records. BMJ 347:f6650CrossRefGoogle Scholar
  11. 11.
    Salpeter SS, Ormiston T, Salpeter E, Poole P, Cates C (2002) Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2:CD003566Google Scholar
  12. 12.
    Rutten FH, Zuithoff NP, Hak E, Grobbee DE, Hoes AW (2010) Beta-blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease. Arch Intern Med 170:880–887CrossRefGoogle Scholar
  13. 13.
    Kuo PL, Lin KC, Tang PL, Cheng CC, Huang WC, Chiang CH, Lin HC, Chuang TJ, Wann SR, Mar GY, Cheng JS, Liu CP (2016) Contribution of hepatitis B to long-term outcome among patients with acute myocardial infarction: a nationwide study. Medicine (Baltimore) 95:e2678CrossRefGoogle Scholar
  14. 14.
    Chiang CH, Huang WC, Yang JS, Cheng CC, Kuo FY, Chiou KR, Lee TY, Lin TW, Mar GY, Chiou CW, Liu CP, Lee KT (2013) Five-year outcomes after acute myocardial infarction in patients with and without diabetes mellitus in Taiwan, 1996–2005. Acta Cardiol Sin 29:387–394Google Scholar
  15. 15.
    Bhatt SP, Connett JE, Voelker H, Lindberg SM, Westfall E, Wells JM, Lazarus SC, Criner GJ, Dransfield MT (2016) Beta-blockers for the prevention of acute exacerbations of chronic obstructive pulmonary disease (betaLOCK COPD): a randomised controlled study protocol. BMJ Open 6:e012292CrossRefGoogle Scholar
  16. 16.
    Huang YL, Lai CC, Wang YH, Wang CY, Wang JY, Wang HC, Yu CJ, Chen L (2017) Impact of selective and nonselective beta-blockers on the risk of severe exacerbations in patients with COPD. Int J Chron Obstruct Pulmon Dis 12:2987–2996CrossRefGoogle Scholar
  17. 17.
    Task Force M, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabate M, Senior R, Taggart DP, van der Wall EE, Vrints CJ, Guidelines ESCCfP, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document R, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Ryden L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL, (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34:2949–3003Google Scholar
  18. 18.
    Short PM, Lipworth SI, Elder DH, Schembri S, Lipworth BJ (2011) Effect of beta blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study. BMJ 342:d2549CrossRefGoogle Scholar
  19. 19.
    Puente-Maestu L, Calle M, Ortega-Gonzalez A, Fuster A, Gonzalez C, Marquez-Martin E, Marcos-Rodriguez PJ, Calero C, Rodriguez-Hermosa JL, Malo de Molina R, Aburto M, Sobradillo P, Alcazar B, Tirado-Conde G, Group G (2014) Multicentric study on the beta-blocker use and relation with exacerbations in COPD. Respir Med 108:737–744CrossRefGoogle Scholar
  20. 20.
    Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DM, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agustí A (2017) Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 195:557–582CrossRefGoogle Scholar
  21. 21.
    Andell P, Erlinge D, Smith JG, Sundstrom J, Lindahl B, James S, Koul S (2015) Beta-blocker use and mortality in COPD patients after myocardial infarction: a Swedish nationwide observational study. J Am Heart Assoc 4:e001611Google Scholar
  22. 22.
    Chen J, Radford MJ, Wang Y, Marciniak TA, Krumholz HM (2001) Effectiveness of beta-blocker therapy after acute myocardial infarction in elderly patients with chronic obstructive pulmonary disease or asthma. J Am Coll Cardiol 37:1950–1956CrossRefGoogle Scholar
  23. 23.
    Heller DA, Ahern FM, Kozak M (2000) Changes in rates of beta-blocker use between 1994 and 1997 among elderly survivors of acute myocardial infarction. Am Heart J 140:663–671CrossRefGoogle Scholar
  24. 24.
    Suissa S, Ernst P (2012) Beta-blockers for COPD inpatients. Thorax 67:936–937CrossRefGoogle Scholar
  25. 25.
    Salpeter SR, Ormiston TM, Salpeter EE, Poole PJ, Cates CJ (2003) Cardioselective beta-blockers for chronic obstructive pulmonary disease: a meta-analysis. Respir Med 97:1094–1101CrossRefGoogle Scholar
  26. 26.
    Finkelstein J, Cha E, Scharf SM (2009) Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis 4:337–349CrossRefGoogle Scholar
  27. 27.
    Bursi F, Vassallo R, Weston SA, Killian JM, Roger VL (2010) Chronic obstructive pulmonary disease after myocardial infarction in the community. Am Heart J 160:95–101CrossRefGoogle Scholar
  28. 28.
    Andell P, Koul S, Martinsson A, Sundstrom J, Jernberg T, Smith JG, James S, Lindahl B, Erlinge D (2014) Impact of chronic obstructive pulmonary disease on morbidity and mortality after myocardial infarction. Open Heart 1:e000002CrossRefGoogle Scholar
  29. 29.
    Campo G, Guastaroba P, Marzocchi A, Santarelli A, Varani E, Vignali L, Sangiorgio P, Tondi S, Serenelli C, De Palma R, Saia F (2013) Impact of COPD on long-term outcome after ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Chest 144:750–757CrossRefGoogle Scholar
  30. 30.
    Enriquez JR, de Lemos JA, Parikh SV, Peng SA, Spertus JA, Holper EM, Roe MT, Rohatgi A, Das SR (2013) Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarction. Am Heart J 165:43–49CrossRefGoogle Scholar
  31. 31.
    Hadi HA, Zubaid M, Al Mahmeed W, El-Menyar AA, Ridha M, Alsheikh-Ali AA, Singh R, Assad N, Al Habib K, Al Suwaidi J (2010) Prevalence and prognosis of chronic obstructive pulmonary disease among 8167 Middle Eastern patients with acute coronary syndrome. Clin Cardiol 33:228–235CrossRefGoogle Scholar
  32. 32.
    Olenchock BA, Fonarow GG, Pan W, Hernandez A, Cannon CP, Get with the Guidelines Steering C (2009) Current use of beta blockers in patients with reactive airway disease who are hospitalized with acute coronary syndromes. Am J Cardiol 103:295–300CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Wen-Hwa Wang
    • 1
    • 2
    • 7
  • Chin-Chang Cheng
    • 1
    • 3
    • 4
  • Guang-Yuan Mar
    • 1
  • Kai-Che Wei
    • 5
  • Wei-Chun Huang
    • 1
    • 3
    • 4
    • 6
    Email author
  • Chun-Peng Liu
    • 1
    • 3
  1. 1.Department of Critical Care MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
  2. 2.I-Shou UniversityKaohsiungTaiwan
  3. 3.School of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  4. 4.Department of Physical TherapyFooyin UniversityKaohsiungTaiwan
  5. 5.Department of DermatologyKaohsiung Veterans General HospitalKaohsiungTaiwan
  6. 6.Section of Critical Care Medicine, Zuoying Dist.Kaohsiung Veterans General HospitalKaohsiungTaiwan
  7. 7.Shu-Zen Junior College of Medicine and ManagementKaohsiungTaiwan

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