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Stefan MS, Rothberg MB, Priya A, Pekow PS, Au DH, Lindenauer PK. Association between ß-blocker therapy and outcomes in patients hospitalised with acute exacerbations of chronic obstructive lung disease with underlying ischaemic heart disease, heart failure or hypertension. Thorax. 2012 Nov 1; 67(11):977-84.
BACKGROUND: -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 -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 -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 blockers in the first two hospital days, including 22% with 1-selective and 7% with non-selective blockers. In a propensity-matched analysis, there was no association between -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 1 selective blockers, receipt of non-selective 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 1-selective blockers during hospitalisation for COPD appears to be safe. Until additional evidence becomes available, 1-selective blockers may be superior to treatment with a non-selective blocker.