Abstract 14186: The Impact of β-blocker Selectivity on Long-term Outcomes in Congestive Heart Failure Patients With Chronic Obstructive Pulmonary Disease
Background: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with congestive heart failure (CHF). β-blocker use has been sometimes avoided in patients with CHF and COPD because of concerning about precipitating respiratory deterioration. Although it has been known that cardioprotective β-blocker did not worse their pulmonary function in CHF patients with COPD, an impact of β-blocker selectivity on long-term outcomes has not been well evaluated in the patients.
Methods: We retrospectively analyzed 132 patients (78.6± 8.1 years, male 82.2%, Ejection Fraction 43.2 ±10.4%) with CHF and COPD who had history of hospitalization at our institute between January 2009 and December 2012. Of patients receiving β blockers at discharge (67.1%), 34 patients (39.5%) received bisoprolol, which was a cardioselective β-blocker, and 52 patients (60.5%) received carvedilol, which was an noncardioselective β-blocker. We compared mortality as primary outcome, and hospitalization rates for CHF or COPD exacerbation as secondary outcome, were between bisoprolol and carvedilol in CHF patients with COPD.
Results: The mean follow-up period was 33.9 months. Baseline characteristics were similar between two groups (with bisoprolol compared to carvedilol). The mortality was higher in CHF patients without β-blocker compared with CHF patients with β-blocker (26.2% and 10.5%, respectively, P=0.039). There was no significant difference between bisoprolol and carvedilol for mortality. However, bisoprolol use was associated with lower rehospitalization rates for CHF or COPD exacerbation compared with carvedilol (17.6% vs. 55.8 %, respectively, p=0.033).
Conclusion: These findings support recommendations to use β blockers in patients with HF with COPD and suggest that bisoprolol lower the COPD or CHF exacerbation compared with carvedilol.
- © 2013 by American Heart Association, Inc.