title: Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease.
abstract: Although β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-blockers for patients with HF and comorbid COPD.
  
  
  
  We evaluated data from the Optimum Patient Care Research Database over a period of 1 year for co-prescribing of β-blockers with either an ACE inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) in patients with HF alone versus HF+COPD. Association with inhaler therapy was also evaluated.
  
  
  
  We identified 89 861 patients with COPD, 24 237 with HF and 10 853 with both conditions. In patients with HF+COPD, the mean age was 79 years; 60% were male, and 27% had prior myocardial infarction. Of patients with HF+COPD, 22% were taking a β-blocker in conjunction with either ACEI/ARB (n=2416) compared with 41% of patients with HF only (n=10 002) (adjusted OR 0.54, 95% CI 0.51 to 0.58, p<0.001). Among HF+COPD patients taking inhaled corticosteroid (ICS) with long-acting β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-blockers (n=1316). Corresponding figures for those patients taking ICS/LABA were 20% (n=583) versus 48% (n=1367), respectively.
  
  
  
  These data indicate a substantial unmet need for patients with COPD who should be prescribed β-blockers more often for concomitant HF.
authors.affiliation: Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Lipworth
authors.affiliation: Optimum Patient Care, Cambridge, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Skinner
authors.affiliation: Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Devereux
authors.affiliation: Cambridge Research Support, Cambridge, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Thomas
authors.affiliation: Observational and Pragmatic Research Institute, Singapore, Singapore.
authors.forename: Joanna
authors.initials: J
authors.lastname: Ling Zhi Jie
authors.affiliation: Research in Real Life, Cambridge, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Martin
authors.affiliation: Optimum Patient Care, Cambridge, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Carter
authors.affiliation: Observational and Pragmatic Research Institute, Singapore, Singapore.|Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: David B
authors.initials: DB
authors.lastname: Price
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D063127:Secondary Health Care; D013997:Time Factors; D006113:United Kingdom
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists