title: Association between β-blocker therapy and outcomes in patients hospitalised with acute exacerbations of chronic obstructive lung disease with underlying ischaemic heart disease, heart failure or hypertension.
abstract: BACKGROUND
  β-Blocker therapy has been shown to improve survival among patients with ischaemic heart disease (IHD) and congestive heart failure (CHF) and is underused among patients with chronic obstructive pulmonary disease (COPD). Evidence regarding the optimal use of β-blocker therapy during an acute exacerbation of COPD is particularly weak.
  
  
  METHODS
  We conducted a retrospective cohort study of patients aged ≥40 years with IHD, CHF or hypertension who were hospitalised for an acute exacerbation of COPD from 1 January 2006 to 1 December 2007 at 404 acute care hospitals throughout the USA. We examined the association between β-blocker therapy and in-hospital mortality, initiation of mechanical ventilation after day 2 of hospitalisation, 30-day all-cause readmission and length of stay.
  
  
  RESULTS
  Of 35 082 patients who met the inclusion criteria, 29% were treated with β blockers in the first two hospital days, including 22% with β1-selective and 7% with non-selective β blockers. In a propensity-matched analysis, there was no association between β-blocker therapy and in-hospital mortality (OR 0.88, 95% CI 0.71 to 1.09), 30-day readmission (OR 0.96, 95% CI 0.89 to 1.03) or late mechanical ventilation (OR 0.98, 95% CI 0.77 to 1.24). However, when compared with β1 selective β blockers, receipt of non-selective β blockers was associated with an increased risk of 30-day readmission (OR 1.25, 95% CI 1.08 to 1.44).
  
  
  CONCLUSIONS
  Among patients with IHD, CHF or hypertension, continuing β1-selective β blockers during hospitalisation for COPD appears to be safe. Until additional evidence becomes available, β1-selective β blockers may be superior to treatment with a non-selective β blocker.
authors.affiliation: Division of General Medicine, Department of Medicine, Baystate Medical Center, Springfield, MA, USA. mihaela.stefan@bhs.org
authors.forename: Mihaela S
authors.initials: MS
authors.lastname: Stefan
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.forename: Aruna
authors.initials: A
authors.lastname: Priya
authors.forename: Penelope S
authors.initials: PS
authors.lastname: Pekow
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
mesh_terms: D000208:Acute Disease; D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D010359:Patient Readmission / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D000319:Adrenergic beta-Antagonists