Egred M, Shaw S, Mohammad B, Waitt P, Rodrigues E
Cardiothoracic Centre, University Hospital Aintree, Liverpool, UK.
QJM. 2005 Jul;98(7):493-7. doi: 10.1093/qjmed/hci080. Epub 2005 Jun 13.
Beta-blockers (BB) improve morbidity and mortality in ischaemic heart disease. There is a general reluctance to use BB, especially in patients with chronic obstructive pulmonary disease (COPD), which is perceived as an absolute contraindication. As large numbers of patients are labelled with COPD without objective evidence, they may miss out on the benefit from these drugs.
To assess the use of BB in patients with COPD admitted with acute coronary syndrome (ACS), and to assess the supporting evidence for the diagnosis of COPD in these patients.
Case-note review and retrospective analysis of 457 consecutive patients admitted with troponin-positive ACS between October 2002 and October 2003.
Of 457 ACS patients studied, 246 (54%) were discharged on a BB. Cardiologists prescribed BB in ACS patients more frequently than did general physicians, (70% vs. 30%, respectively). The reasons for withholding BB were: not documented 27%, COPD 33%, heart failure 24%, others 16%. Ninety-four patients (21%) had a diagnosis of COPD; only 58 (62%) of these had been reviewed by a chest physician or had previous pulmonary function tests. Of the 94 patients with COPD, only 15 (16%) were prescribed BB during the admission: 9 by cardiologists and 6 by non-cardiologists. BB were discontinued in two patients due to an increase in dyspnoea.
Many patients with a diagnosis of COPD have no objective evidence to support the diagnosis and are denied the prognostic benefits of BB when presenting with ACS. Before withholding beta-blockers, COPD and reversibility should be ascertained by pulmonary function testing. The overall use of beta-blockers remains sub-optimal and could be improved in this setting.
β受体阻滞剂（BB）可改善缺血性心脏病的发病率和死亡率。人们普遍不愿意使用BB，尤其是在慢性阻塞性肺疾病（COPD）患者中，COPD被视为绝对禁忌证。由于大量患者在没有客观证据的情况下被诊断为COPD，他们可能无法从这些药物中获益。
评估BB在因急性冠状动脉综合征（ACS）入院的COPD患者中的使用情况，并评估这些患者中COPD诊断的支持证据。
对2002年10月至2003年10月期间连续收治的457例肌钙蛋白阳性ACS患者进行病例记录回顾和回顾性分析。
在研究的457例ACS患者中，246例（54%）出院时使用了BB。心脏病专家在ACS患者中开具BB的频率高于普通内科医生（分别为70%和30%）。停用BB的原因有：未记录27%、COPD 33%、心力衰竭24%、其他16%。94例患者（21%）被诊断为COPD；其中只有58例（62%）接受过胸科医生的检查或之前进行过肺功能测试。在94例COPD患者中，入院期间只有15例（16%）使用了BB：心脏病专家开具9例，非心脏病专家开具6例。2例患者因呼吸困难加重而停用BB。
许多诊断为COPD的患者没有客观证据支持该诊断，在出现ACS时被剥夺了BB的预后益处。在停用β受体阻滞剂之前，应通过肺功能测试确定COPD及其可逆性。β受体阻滞剂的总体使用仍未达到最佳水平，在这种情况下可以得到改善。
