Acute heart failure with accompanying chronic obstructive pulmonary disease: should we focus on beta blockers?
BACKGROUND
Acute heart failure (AHF) with systolic dysfunction is associated with increased morbidity and mortality, and optimal therapy is not well established, despite the findings of evidence-based medicine. Beta blockers provide a mortality and morbidity benefit in patients with chronic systolic HF, and are currently indicated in all stages of patients with systolic HF. We evaluated therapies before discharge, in particular beta blockers, in patients hospitalized with AHF with and without accompanying chronic obstructive pulmonary disease (COPD).


METHODS
The hospital discharge records of 959 consecutive de novo AHF patients, hospitalized and treated for systolic HF (ejection fraction < 45%), were retrospectively reviewed in three cardiovascular institutions.


RESULTS
The presence of accompanying COPD was associated with significantly lower prescription of beta blockers before discharge (p < 0.001). Furthermore, with regard to the type of beta blocker, patients with accompanying COPD were less frequently prescribed nonselective beta blockers (29% vs. 48%, p < 0.001). The presence of accompanying COPD among AHF patients increased the risk of omitting (not prescribing) beta blockers before discharge by a factor of 1.785.


CONCLUSIONS
Beta blockers, a proven life-saving therapy in the setting of chronic systolic HF, were found to be less frequently prescribed before discharge in the presence of de novo AHF with accompanying COPD.
Clinic of Cardiology, Kavaklidere Umut Hospital, Buklum sokak, No: 72, Ankara, Turkey. drmeltemege@yahoo.com.tr
M R
MR
Ege
U
U
Guray
Y
Y
Guray
M B
MB
Yilmaz
O
O
Yucel
A
A
Zorlu
I
I
Tandogan
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology*; D012307:Risk Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists