title: Effect of β-blockers on cardiac and pulmonary events and death in older adults with cardiovascular disease and chronic obstructive pulmonary disease.
abstract: BACKGROUND
  In older adults with multiple conditions, medications may not impart the same benefits seen in patients who are younger or without multimorbidity. Furthermore, medications given for one condition may adversely affect other outcomes. β-Blocker use with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is such a situation.
  
  
  OBJECTIVE
  To determine the effect of β-blocker use on cardiac and pulmonary outcomes and mortality in older adults with coexisting COPD and CVD.
  
  
  METHODS
  The study included 1062 participants who were members of the 2004-2007 Medicare Current Beneficiary Survey cohorts, a nationally representative sample of Medicare beneficiaries. Study criteria included age over 65 years plus coexisting CVD and COPD/asthma. Follow-up occurred through 2009. We determined the association between β-blocker use and the outcomes with propensity score-adjusted and covariate-adjusted Cox proportional hazards.
  
  
  METHODS
  The 3 outcomes were major cardiac events, pulmonary events, and all-cause mortality.
  
  
  RESULTS
  Half of the participants used β-blockers. During follow-up, 179 participants experienced a major cardiac event; 389 participants experienced a major pulmonary event; and 255 participants died. Each participant could have experienced any ≥1 of these events. The hazard ratio for β-blocker use was 1.18 [95% confidence interval (CI), 0.85-1.62] for cardiac events, 0.91 (95% CI, 0.73-1.12) for pulmonary events, and 0.87 (95% CI, 0.67-1.13) for death.
  
  
  CONCLUSIONS
  In this population of older adults, β-blockers did not seem to affect occurrence of cardiac or pulmonary events or death in those with CVD and COPD.
authors.affiliation: *Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR †Department of Medicine, Yale School of Medicine ‡Yale School of Public Health, New Haven, CT.
authors.forename: David S H
authors.initials: DS
authors.lastname: Lee
authors.forename: Sheila
authors.initials: S
authors.lastname: Markwardt
authors.forename: Gail J
authors.initials: GJ
authors.lastname: McAvay
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.forename: Leah M
authors.initials: LM
authors.lastname: Goeres
authors.forename: Ling
authors.initials: L
authors.lastname: Han
authors.forename: Peter
authors.initials: P
authors.lastname: Peduzzi
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D016017:Odds Ratio; D011320:Primary Health Care / Q000458:organization & administration*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists