Association of Beta-Blocker Use and Selectivity With Outcomes in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease (from OPTIMIZE-HF)

In patients with heart failure (HF) with chronic obstructive pulmonary disease (COPD), concerns exist regarding beta blockers, particularly noncardioselective beta blockers, precipitating bronchospasm or attenuating the benefit of inhaled beta(2) agonists. The aim of this study was to test the hypothesis that noncardioselective beta blockers would not be associated with worse outcomes compared with cardioselective beta blockers in patients with concomitant COPD in a large HF registry. A retrospective analysis of patients from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) who had systolic dysfunction, documentation of beta-blocker status, and follow-up information available after index hospitalization (n = 2,670) was performed. The associations between cardioselective and noncardioselective beta blockers and the end points of 60- to 90-day mortality and mortality or rehospitalization in patients with (n = 722) and without (n = 1,948) COPD were analyzed using regression modeling. The models were adjusted for covariate predictors of beta-blocker use at discharge and clinical predictors of outcomes. Noncardioselective and cardioselective beta blockers were associated with lower risk-adjusted mortality in patients with and without COPD. There was no evidence that beta-blocker selectivity was associated with a difference in outcomes between patients with and those without COPD (p for interaction >0.10 for both outcomes). In conclusion, despite concerns regarding beta blockers in patients with HF with COPD, there was no evidence that beta-blocker selectivity was associated with differences in outcomes for patients with HF with COPD versus those without. (C) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:582-587)