CLINICAL STUDY: DIASTOLIC DYSFUNCTION
Effectiveness of beta-blocker therapy after acute myocardial infarction in elderly patients with chronic obstructive pulmonary disease or asthma
Jersey Chen, MD, MPH*,1,
Martha J. Radford, MD, FACC*   ,
Yun Wang, MS ,
Thomas A. Marciniak, MD and
Harlan M. Krumholz, MD, FACC* ||
* Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
Qualidigm, Middletown, Connecticut, USA
Health Care Financing Administration, Baltimore, Maryland, USA
|| Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
Manuscript received August 22, 2000;
revised manuscript received January 24, 2001,
accepted February 6, 2001.
Reprint requests and correspondence: Dr. Harlan M. Krumholz, 333 Cedar Street, P.O. Box 208025, New Haven, Connecticut 06520-8025
harlan.krumholz{at}yale.edu
OBJECTIVES
We evaluated the use and effectiveness of beta-blocker therapy after acute myocardial infarction (AMI) for elderly patients with chronic obstructive pulmonary disease (COPD) or asthma.
BACKGROUND
Because patients with COPD and asthma have largely been excluded from clinical trials of beta-blocker therapy for AMI, the extent to which these patients would benefit from beta-blocker therapy after AMI is not well defined.
METHODS
Using data from the Cooperative Cardiovascular Project, we examined the relationship between discharge use of beta-blockers and one-year mortality in patients with COPD or asthma who were not using beta-agonists, patients with COPD or asthma who were concurrently using beta-agonists and patients with evidence of severe disease (use of prednisone or previous hospitalization for COPD or asthma) compared with patients without COPD or asthma.
RESULTS
Of 54,962 patients without contraindications to beta-blockers, patients with COPD or asthma (20%) were significantly less likely to be prescribed beta-blockers at discharge after AMI. After adjusting for demographic and clinical factors, we found that beta-blockers were associated with lower one-year mortality in patients with COPD or asthma who were not on beta-agonist therapy (relative risk [RR] = 0.85, 95% confidence interval [CI] 0.73 to 1.00), similar to patients without COPD or asthma (RR = 0.86, 95% CI 0.81 to 0.92). A survival benefit for beta-blockers was not found among patients concurrently using beta-agonists or with severe COPD or asthma.
CONCLUSIONS
Beta-blocker therapy after AMI may be beneficial for COPD or asthma patients with mild disease. A survival benefit was not found for elderly AMI patients with more severe pulmonary disease.
|
Abbreviations and Acronyms
| | ACC | = American College of Cardiology | | AHA | = American Heart Association | | AMI | = acute myocardial infarction | | BHAT | = Beta-Blocker Heart Attack Trial | | CCP | = Cooperative Cardiovascular Project | | CI | = confidence interval | | CK | = creatine kinase | | COPD | = chronic obstructive pulmonary disease | | ICD-9-CM | = International Classification of Diseases, Ninth Revision, Clinical Modification | | LDH | = lactate dehydrogenase | | MIAMI | = Metoprolol In Acute Myocardial Infarction trial | | OR | = odds ratio | | RR | = relative risk |
|
This article has been cited by other articles:
|
|
|
|
 
N. M. Hawkins, Z. Huang, K. S. Pieper, S. D. Solomon, L. Kober, E. J. Velazquez, K. Swedberg, M. A. Pfeffer, J. J.V. McMurray, A. P. Maggioni, et al.
Chronic obstructive pulmonary disease is an independent predictor of death but not atherosclerotic events in patients with myocardial infarction: analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT)
Eur J Heart Fail,
March 1, 2009;
11(3):
292 - 298.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M T Dransfield, S M Rowe, J Johnson, W Bailey, and L Gerald
Authors' response
Thorax,
November 1, 2008;
63(11):
1027 - 1027.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. M. Ho, P. N. Peterson, and F. A. Masoudi
Evaluating the Evidence: Is There a Rigid Hierarchy?
Circulation,
October 14, 2008;
118(16):
1675 - 1684.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. R. B. M. van Gestel, S. E. Hoeks, D. D. Sin, G. M. J. M. Welten, O. Schouten, H. J. Witteveen, C. Simsek, H. Stam, F. W. Mertens, J. J. Bax, et al.
Impact of Cardioselective {beta}-Blockers on Mortality in Patients with Chronic Obstructive Pulmonary Disease and Atherosclerosis
Am. J. Respir. Crit. Care Med.,
October 1, 2008;
178(7):
695 - 700.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. M. Krumholz
Outcomes Research: Generating Evidence for Best Practice and Policies
Circulation,
July 15, 2008;
118(3):
309 - 318.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Kamio, T. Sato, X. Liu, H. Sugiura, S. Togo, T. Kobayashi, S. Kawasaki, X. Wang, L. Mao, Y. Ahn, et al.
Prostacyclin analogs stimulate VEGF production from human lung fibroblasts in culture
Am J Physiol Lung Cell Mol Physiol,
June 1, 2008;
294(6):
L1226 - L1232.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. H Au
Use of {beta} blockers in patients with COPD
Thorax,
April 1, 2008;
63(4):
296 - 298.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. H. Le Jemtel, M. Padeletti, and S. Jelic
Diagnostic and Therapeutic Challenges in Patients With Coexistent Chronic Obstructive Pulmonary Disease and Chronic Heart Failure
J. Am. Coll. Cardiol.,
January 16, 2007;
49(2):
171 - 180.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Egred, S. Shaw, B. Mohammad, P. Waitt, and E. Rodrigues
Under-use of beta-blockers in patients with ischaemic heart disease and concomitant chronic obstructive pulmonary disease
QJM,
July 1, 2005;
98(7):
493 - 497.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Weiner, T E Stump, C M Callahan, J N Lewis, and C J McDonald
Pursuing integration of performance measures into electronic medical records: beta-adrenergic receptor antagonist medications
Qual. Saf. Health Care,
April 1, 2005;
14(2):
99 - 106.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. E. Sirak, S. Jelic, and T. H. Le Jemtel
Therapeutic update: Non-selective beta- and alpha-adrenergic blockade in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure
J. Am. Coll. Cardiol.,
August 4, 2004;
44(3):
497 - 502.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Task Force Members, J. Lopez-Sendo, K. Swedberg, J. McMurray, J. Tamargo, A. P. Maggioni, H. Dargie, M. Tendera, F. Waagstein, J. Kjekshus, et al.
Expert consensus document on {beta}-adrenergic receptor blockers: The Task Force on Beta-Blockers of the European Society of Cardiology
Eur. Heart J.,
August 1, 2004;
25(15):
1341 - 1362.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Muntwyler, A. Cohen-Solal, N. Freemantle, J. Eastaugh, J. G. Cleland, and F. Follath
Relation of sex, age and concomitant diseases to drug prescription for heart failure in primary care in Europe
Eur J Heart Fail,
August 1, 2004;
6(5):
663 - 668.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Perschbacher, G. S. Reeder, S. J. Jacobsen, S. A. Weston, J. M. Killian, A. Slobodova, and V. L. Roger
Evidence-Based Therapies for Myocardial Infarction: Secular Trends and Determinants of Practice in the Community
Mayo Clin. Proc.,
August 1, 2004;
79(8):
983 - 991.
[Abstract]
[PDF]
|
|
|
|
|
|
|
E. Kjoller, L. Kober, K. Iversen, C. Torp-Pedersen, and Trace Study Group
Importance of chronic obstructive pulmonary disease for prognosis and diagnosis of congestive heart failure in patients with acute myocardial infarction
Eur J Heart Fail,
January 1, 2004;
6(1):
71 - 77.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R Andrus, K. P Holloway, and D. B Clark
Use of {beta}-Blockers in Patients with COPD
Ann. Pharmacother.,
January 1, 2004;
38(1):
142 - 145.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. L. Croxton, G. G. Weinmann, R. M. Senior, R. A. Wise, J. D. Crapo, and A. S. Buist
Clinical Research in Chronic Obstructive Pulmonary Disease: Needs and Opportunities
Am. J. Respir. Crit. Care Med.,
April 15, 2003;
167(8):
1142 - 1149.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Butler, P. G. Arbogast, R. BeLue, J. Daugherty, M. K. Jain, W. A. Ray, and M. R. Griffin
Outpatient adherence to beta-blocker therapy after acute myocardial infarction
J. Am. Coll. Cardiol.,
November 6, 2002;
40(9):
1589 - 1595.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. B Stanbrook
Review: cardioselective {beta}-blockers did not reduce respiratory function in patients with chronic obstructive pulmonary disease
Evid. Based Med.,
November 1, 2002;
7(6):
181 - 181.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. Califf and D. L. DeMets
Principles From Clinical Trials Relevant to Clinical Practice: Part I
Circulation,
August 20, 2002;
106(8):
1015 - 1021.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Pritchett and M. M. Redfield
{beta}-Blockers: New Standard Therapy for Heart Failure
Mayo Clin. Proc.,
August 1, 2002;
77(8):
839 - 846.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. Gheorghiade and S. Goldstein
{beta}-Blockers in the Post-Myocardial Infarction Patient
Circulation,
July 23, 2002;
106(4):
394 - 398.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Farrell, J. M. Foody, and H. M. Krumholz
{beta}-Blockers in Heart Failure: Clinical Applications
JAMA,
February 20, 2002;
287(7):
890 - 897.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Radford and J. M. Foody
How Do Observational Studies Expand the Evidence Base for Therapy?
JAMA,
September 12, 2001;
286(10):
1228 - 1230.
[Full Text]
[PDF]
|
|
|
|
