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 journalArticle

10 Citations (Scopus)

Abstract

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
DOIs
Publication statusAccepted/In press - Jan 1 2017

Fingerprint

Nebivolol
Chronic Obstructive Pulmonary Disease
Cohort Studies
Heart Failure
Bisoprolol
Metoprolol
Confidence Intervals
Hospitalization
Prescriptions
Odds Ratio
carvedilol
Chronic Renal Insufficiency
Logistic Models
Guidelines

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relationship between heart failure, concurrent chronic obstructive pulmonary disease and beta-blocker use : A Danish nationwide cohort study. / Sessa, Maurizio; Mascolo, Annamaria; Mortensen, Rikke Nørmark; Andersen, Mikkel Porsborg; Rosano, Giuseppe Massimo Claudio; Capuano, Annalisa; Rossi, Francesco; Gislason, Gunnar; Enghusen-Poulsen, Henrik; Torp-Pedersen, Christian.

In: European Journal of Heart Failure, 01.01.2017.

Research output: Contribution to journalArticle

Sessa, Maurizio ; Mascolo, Annamaria ; Mortensen, Rikke Nørmark ; Andersen, Mikkel Porsborg ; Rosano, Giuseppe Massimo Claudio ; Capuano, Annalisa ; Rossi, Francesco ; Gislason, Gunnar ; Enghusen-Poulsen, Henrik ; Torp-Pedersen, Christian. / Relationship between heart failure, concurrent chronic obstructive pulmonary disease and beta-blocker use : A Danish nationwide cohort study. In: European Journal of Heart Failure. 2017.
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abstract = "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.",
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AU - Sessa, Maurizio

AU - Mascolo, Annamaria

AU - Mortensen, Rikke Nørmark

AU - Andersen, Mikkel Porsborg

AU - Rosano, Giuseppe Massimo Claudio

AU - Capuano, Annalisa

AU - Rossi, Francesco

AU - Gislason, Gunnar

AU - Enghusen-Poulsen, Henrik

AU - Torp-Pedersen, Christian

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N2 - 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.

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KW - Chronic obstructive pulmonary disease

KW - Clinical guidelines

KW - Denmark

KW - Heart failure

KW - Hospitalization

KW - Non-cardio-selective β-blockers

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