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Carvedilol, Bisoprolol, and Metoprolol Use in Patients With Coexistent Heart Failure and Chronic Obstructive Pulmonary Disease

Beta (β)-blockers are under-prescribed in patients with heart failure (HF) and concurrent chronic obstructive pulmonary disease (COPD) due to concerns about adverse pulmonary effects and a poor understanding of the effects of these drugs. We aimed to evaluate the survival effects of β-blockers in pa...

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Autores principales: Su, Vincent Yi-Fong, Chang, Yu-Sheng, Hu, Yu-Wen, Hung, Man-Hsin, Ou, Shuo-Ming, Lee, Fa-Yauh, Chou, Kun-Ta, Yang, Kuang-Yao, Perng, Diahn-Warng, Chen, Tzeng-Ji, Liu, Chia-Jen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748871/
https://www.ncbi.nlm.nih.gov/pubmed/26844454
http://dx.doi.org/10.1097/MD.0000000000002427
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author Su, Vincent Yi-Fong
Chang, Yu-Sheng
Hu, Yu-Wen
Hung, Man-Hsin
Ou, Shuo-Ming
Lee, Fa-Yauh
Chou, Kun-Ta
Yang, Kuang-Yao
Perng, Diahn-Warng
Chen, Tzeng-Ji
Liu, Chia-Jen
author_facet Su, Vincent Yi-Fong
Chang, Yu-Sheng
Hu, Yu-Wen
Hung, Man-Hsin
Ou, Shuo-Ming
Lee, Fa-Yauh
Chou, Kun-Ta
Yang, Kuang-Yao
Perng, Diahn-Warng
Chen, Tzeng-Ji
Liu, Chia-Jen
author_sort Su, Vincent Yi-Fong
collection PubMed
description Beta (β)-blockers are under-prescribed in patients with heart failure (HF) and concurrent chronic obstructive pulmonary disease (COPD) due to concerns about adverse pulmonary effects and a poor understanding of the effects of these drugs. We aimed to evaluate the survival effects of β-blockers in patients with coexistent HF and COPD. Using the Taiwan National Health Insurance Research Database, we conducted a nationwide population-based study. Patients with coexistent HF and COPD diagnosed between 2000 and 2009 were enrolled. Doses of the 3 β-blockers proven to be beneficial to HF (carvedilol, bisoprolol, and metoprolol) during the study period were extracted. The primary endpoint was cumulative survival. Patients were followed until December 31, 2009. The study included 11,558 subjects, with a mean follow-up period of 4.07 years. After adjustment for age, sex, comorbidities, and severity of HF and COPD, bisoprolol use showed a dose–response survival benefit [low dose: adjusted hazard ratio (HR) = 0.76, 95% confidence interval (CI) = 0.59–0.97, P = 0.030; high dose: adjusted HR = 0.40, 95% CI = 0.26–0.63, P < 0.001] compared with nonusers, whereas no survival difference was observed for carvedilol or metoprolol. Compared with patients with HF alone, this special HF + COPD cohort received significantly fewer targeted β-blockers (108.8 vs 137.3 defined daily doses (DDDs)/person-year, P < 0.001) and bisoprolol (57.9 vs 70.8 DDDs/person-year, P < 0.001). In patients with coexisting HF and COPD, this study demonstrated a dose–response survival benefit of bisoprolol use, but not of carvedilol or metoprolol use.
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spelling pubmed-47488712016-04-01 Carvedilol, Bisoprolol, and Metoprolol Use in Patients With Coexistent Heart Failure and Chronic Obstructive Pulmonary Disease Su, Vincent Yi-Fong Chang, Yu-Sheng Hu, Yu-Wen Hung, Man-Hsin Ou, Shuo-Ming Lee, Fa-Yauh Chou, Kun-Ta Yang, Kuang-Yao Perng, Diahn-Warng Chen, Tzeng-Ji Liu, Chia-Jen Medicine (Baltimore) 5800 Beta (β)-blockers are under-prescribed in patients with heart failure (HF) and concurrent chronic obstructive pulmonary disease (COPD) due to concerns about adverse pulmonary effects and a poor understanding of the effects of these drugs. We aimed to evaluate the survival effects of β-blockers in patients with coexistent HF and COPD. Using the Taiwan National Health Insurance Research Database, we conducted a nationwide population-based study. Patients with coexistent HF and COPD diagnosed between 2000 and 2009 were enrolled. Doses of the 3 β-blockers proven to be beneficial to HF (carvedilol, bisoprolol, and metoprolol) during the study period were extracted. The primary endpoint was cumulative survival. Patients were followed until December 31, 2009. The study included 11,558 subjects, with a mean follow-up period of 4.07 years. After adjustment for age, sex, comorbidities, and severity of HF and COPD, bisoprolol use showed a dose–response survival benefit [low dose: adjusted hazard ratio (HR) = 0.76, 95% confidence interval (CI) = 0.59–0.97, P = 0.030; high dose: adjusted HR = 0.40, 95% CI = 0.26–0.63, P < 0.001] compared with nonusers, whereas no survival difference was observed for carvedilol or metoprolol. Compared with patients with HF alone, this special HF + COPD cohort received significantly fewer targeted β-blockers (108.8 vs 137.3 defined daily doses (DDDs)/person-year, P < 0.001) and bisoprolol (57.9 vs 70.8 DDDs/person-year, P < 0.001). In patients with coexisting HF and COPD, this study demonstrated a dose–response survival benefit of bisoprolol use, but not of carvedilol or metoprolol use. Wolters Kluwer Health 2016-02-08 /pmc/articles/PMC4748871/ /pubmed/26844454 http://dx.doi.org/10.1097/MD.0000000000002427 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial License, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be used commercially. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle 5800
Su, Vincent Yi-Fong
Chang, Yu-Sheng
Hu, Yu-Wen
Hung, Man-Hsin
Ou, Shuo-Ming
Lee, Fa-Yauh
Chou, Kun-Ta
Yang, Kuang-Yao
Perng, Diahn-Warng
Chen, Tzeng-Ji
Liu, Chia-Jen
Carvedilol, Bisoprolol, and Metoprolol Use in Patients With Coexistent Heart Failure and Chronic Obstructive Pulmonary Disease
title Carvedilol, Bisoprolol, and Metoprolol Use in Patients With Coexistent Heart Failure and Chronic Obstructive Pulmonary Disease
title_full Carvedilol, Bisoprolol, and Metoprolol Use in Patients With Coexistent Heart Failure and Chronic Obstructive Pulmonary Disease
title_fullStr Carvedilol, Bisoprolol, and Metoprolol Use in Patients With Coexistent Heart Failure and Chronic Obstructive Pulmonary Disease
title_full_unstemmed Carvedilol, Bisoprolol, and Metoprolol Use in Patients With Coexistent Heart Failure and Chronic Obstructive Pulmonary Disease
title_short Carvedilol, Bisoprolol, and Metoprolol Use in Patients With Coexistent Heart Failure and Chronic Obstructive Pulmonary Disease
title_sort carvedilol, bisoprolol, and metoprolol use in patients with coexistent heart failure and chronic obstructive pulmonary disease
topic 5800
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748871/
https://www.ncbi.nlm.nih.gov/pubmed/26844454
http://dx.doi.org/10.1097/MD.0000000000002427
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