Relationship between heart failure, concurrent chronic obstructive pulmonary disease and beta-blocker use: A Danish nationwide cohort study

Maurizio Sessa, Annamaria Mascolo, Rikke Nørmark Mortensen, Mikkel Porsborg Andersen, Giuseppe Massimo Claudio Rosano, Annalisa Capuano, Francesco Rossi, Gunnar Gislason, Henrik Enghusen-Poulsen, Christian Torp-Pedersen

Research output: Contribution to journalArticlepeer-review


Aims: To compare the hazard of all-cause, chronic obstructive pulmonary disease (COPD) and heart failure (HF) hospitalization in carvedilol vs. metoprolol/bisoprolol/nebivolol users with COPD and concurrent HF from 2009 to 2012, and to evaluate the use and persistence in treatment of these β-blockers, their impact on the risk of COPD-related hospitalization, and the factors important for their selection. Methods and results: Cox and logistic regression were used for both unadjusted and adjusted analyses. Carvedilol users had a higher hazard of being hospitalized for HF compared with metoprolol/bisoprolol/nebivolol users in both the unadjusted [hazard ratio (HR) 1.74; 95% confidence interval (CI) 1.65-1.83] and adjusted (HR 1.61; 95% CI 1.52-1.70) analyses. No significant differences were found for all-cause and COPD hospitalization between the two groups. Carvedilol users had a significant lower restricted mean persistence time than metoprolol/bisoprolol/nebivolol users. Patients exposed to carvedilol had an odds ratio (OR) of 1.38 (95% CI 1.23-1.56) for being hospitalized due to COPD within 60days after redeeming the first carvedilol prescription, which was similar to that observed in metoprolol/bisoprolol/nebivolol users (OR 1.37; 95% CI 1.27-1.48). Patients with concurrent chronic kidney disease had a higher probability of receiving carvedilol (OR 1.16; 95% CI 1.04-1.29). Conclusion: Carvedilol prescription carried an increased hazard of HF hospitalization and lower restricted mean persistence time among patients with COPD and concurrent HF. Additionally, we found a widespread phenomenon of carvedilol prescription at variance with the European Society of Cardiology guidelines and potential for improving the proportion of patients treated with β-blockers.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Publication statusAccepted/In press - Jan 1 2017


  • Carvedilol
  • Chronic obstructive pulmonary disease
  • Clinical guidelines
  • Denmark
  • Heart failure
  • Hospitalization
  • Non-cardio-selective β-blockers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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