Beta-Blockers Reduce Mortality in Patients With COPD After Vascular Surgery

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Title: Beta-Blockers Reduce Mortality in Patients With COPD After Vascular Surgery
URL: http://www.pslgroup.com/dg/22DF8E.htm
Doctor's Guide
October 1, 2008

NEW YORK -- October 1, 2008 -- Contrary to previous thought, beta-blockers significantly reduce mortality in patients with chronic obstructive pulmonary disease (COPD) patients, according to a study in the October issue of the American Journal of Respiratory and Critical Care Medicine.

"Patients with COPD frequently have unrecognised, atherosclerotic disease. This is also a major cause for late morbidity and mortality," said principal investigator Don Poldermans, MD, Erasmus Medical Center, Rotterdam, the Netherlands.

To determine the effect of beta-blockers on patients with COPD undergoing vascular surgery, the researchers evaluated the mortality outcomes of more than 3,000 consecutive patients who underwent vascular surgery at the Erasmus Medical Center between 1990 and 2006.

They specifically looked at the effect of a low dose of beta-blockers (<25% maximum recommended therapeutic dose) versus an "intensified" dosage (>25% maximum recommended therapeutic dose).

Of the 3,371 patients evaluated, 31% received cardioselective beta-blockers at their initial hospitalisation. There was no apparent clinical differences between the patients with COPD -- 39% of the entire study sample -- and those without in terms of the likelihood of them receiving beta-blockers.

They found that cardioselective beta-blockers were independently associated with reduced 30-day mortality in both patients with and without COPD. In the 30 days after surgery, COPD patients who did not receive beta-blockers were twice as likely to die as those who did (8% vs 4%).

During the follow-up period, 40% of patients with COPD on beta-blockers died, whereas 67% who were not on beta-blockers died.

"What was observed in the population, beta-blockers, especially, cardioselective beta-blockers like bisoprolol are well tolerated by COPD patients without inducing respiratory adverse effects. More importantly, they improve outcome, by preventing late cardiac events, a major cause for late morbidity and mortality," said Dr. Poldermans.

They also found that in patients with COPD, an intensified dose, but not a low dose, of beta-blockers was associated with reduced 30-day mortality, but in the long term, both intensified and low dosages were associated with similar reductions in mortality. In patients without COPD, both low and intensified doses were associated with reduced mortality in 30-days but in the long term, only the intensified dose was associated with a nonsignificant trend in reduced mortality.

"We found that an intensified dosing regimen appeared to be superior to low-dose therapy in terms of its impact on 30-day mortality," said Dr. Poldermans. "We [demonstrated] among a large group of well-characterised patients with COPD … that beta-blockers were safe and beneficial in prolonging survival after major vascular surgery."

"The indications of our findings are that a high-dose might be preferred in the COPD population," he said. "The safety of cardioselective beta-blockers in the COPD population will support their use."

SOURCE: American Thoracic Society

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