Objective:
To evaluate beta blocker persistence six months after beta-blocker
initiation or dose titration in heart failure (HF) patients with
COPD compared to those without COPD. Secondary objectives included
comparison of beta-blocker dose achieved, changes in left ventricular
ejection fraction (LVEF) and incidence of hospitalizations or
emergency department (ED) visits during follow-up.
Methods: We conducted a matched, retrospective, cohort study including
86 patients with COPD plus concomitant HF (LVEF =40%) and 137
patients with HF alone. All patients were followed in an outpatient
HF clinic. Eligible patients had a documented LVEF =40% and were
initiated or titrated on a beta-blocker in the HF clinic. Patients
were matched based on LVEF (categorized as = 20% or 21-40%), gender,
and age (> or =70 years). The primary outcome was beta blocker
persistence at 6 months. Secondary outcomes were dose achieved,
LVEF, and incidence of hospitalizations or ED visits.
Results: There were no differences between the COPD and non-COPD
groups in beta-blocker persistence at six-month follow-up (94.2%
vs. 93.4% respectively, adjusted p=0.842). The proportion of patients
who achieved a daily metoprolol dose equivalent of at least 100
mg was similar between the groups (adjusted p=0.188). The percent
of patients with at least one ED visit or hospitalization in the
six-month post-titration period was substantial but similar between
the groups (53.5% and 48.2% for COPD and non-COPD patients, respectively,
adjusted p=0.169).
Conclusion: Our results support the use of beta-blockers in the
population of heart failure patients with COPD and without reactive
airway disease.
