Beta-blockers under-prescribed in COPD


By Tony James

10 Nov 2016

More use of beta-blockers in COPD patients with heart failure or a history of acute myocardial infarction presents a significant opportunity for better quality care, Melbourne doctors claim.

Dr Pieter Neef and colleagues including Professors Christine McDonald and Lou Irving found that only 45% of patients admitted for acute exacerbations of COPD with known cardiac indications were being treated with cardioselective beta-blockers.

“Their use in patients with mild to moderate COPD has been proven to be safe in regards to long-term respiratory function and symptoms,” they wrote in the Internal Medicine Journal.

“COPD is no longer recognised as a definite contraindication and most patients are considered good candidates for the use of cardioselective beta-blockers in comorbid cardiac disease.”

Mortality and morbidity benefits of beta-blockers in patients after AMI or in the presence of heart failure with reduced ejection fraction were also obtained in those who also had COPD.

“This is particularly important considering that a significant proportion of mortality in patients with COPD is attributable to cardiovascular disease,” they said.

The research team reviewed the records of 1,071 COPD patients admitted to Austin Health and Melbourne Health. There were 453 (42%) with an identified indication for a beta-blocker, but only 203 of these (45%) were being treated.

The prescription rate was 31% in those with heart failure with reduced ejection fraction alone, and 35% in patients who had had an AMI.

The use of beta-blockers increased to 72% in the high-risk group who had both heart failure and a previous AMI.

“Even in this high-risk group we identified significant potential for quality improvement in the 28% of these patients not receiving beta-blocker therapy,” they said.

Only 4% of all patients with an indication for a beta-blocker had significant bronchodilator reversibility on spirometry.

“The cause for under-prescribing in our cohort remains unclear,” they said.

International studies had consistently shown under-treatment, perhaps reflecting therapeutic nihilism for COPD patients, or a lack of awareness of the benefits of effectively treating cardiovascular disease in COPD.

Another study had shown that cardiologists and respiratory physicians were equally willing to prescribe beta-blockers when indicated, but cardiologists were more likely to prescribe in subgroups with a high risk of bronchoconstriction, perhaps because of a better understanding of the benefits.

“We encourage clinicians to ensure that these patients’ medical management is optimised and appropriate beta-blocker therapy is not overlooked,” the Melbourne team concluded.

Related story: Beta-blockers reduce exacerbations in COPD

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