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

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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.

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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

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Acknowledgement

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

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Authors and Affiliations

  1. Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Wen-Hwa Wang, Chin-Chang Cheng, Guang-Yuan Mar, Wei-Chun Huang & Chun-Peng Liu

  2. I-Shou University, Kaohsiung, Taiwan

    Wen-Hwa Wang

  3. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Chin-Chang Cheng, Wei-Chun Huang & Chun-Peng Liu

  4. Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan

    Chin-Chang Cheng & Wei-Chun Huang

  5. Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Kai-Che Wei

  6. Section of Critical Care Medicine, Zuoying Dist., Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Kaohsiung, 813, Taiwan

    Wei-Chun Huang

  7. Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan

    Wen-Hwa Wang

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  1. Wen-Hwa Wang
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Correspondence to Wei-Chun Huang.

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Wang, WH., Cheng, CC., Mar, GY. et al. Improving outcomes in chronic obstructive pulmonary disease by taking beta-blockers after acute myocardial infarction: a nationwide observational study. Heart Vessels 34, 1158–1167 (2019). https://doi.org/10.1007/s00380-019-01341-0

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  • DOI: https://doi.org/10.1007/s00380-019-01341-0

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