Lim Kuan Pin, Loughrey Sarah, Musk Michael, Lavender Melanie, Wrobel Jeremy P
Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia.
Respiratory Department, Fiona Stanley Hospital, Murdoch, WA, Australia.
Int J Chron Obstruct Pulmon Dis. 2017 Oct 17;12:3041-3046. doi: 10.2147/COPD.S144333. eCollection 2017.
Cardiovascular (CVS) comorbidities are common in COPD and contribute significantly to morbidity and mortality, especially following acute exacerbations of COPD (AECOPD). Beta-blockers (BBs) are safe and effective in COPD patients, with demonstrated survival benefit following myocardial infarction. We sought to determine if BBs are under-prescribed in patients hospitalized with AECOPD. We also sought to determine inpatient rates of CVS and cerebrovascular complications, and their impact on patient outcomes.
Retrospective hospital data was collected over a 12-month period. The medical records of all patients >40 years of age coded with a diagnosis of AECOPD were analyzed. Prevalent use and incident initiation of BBs were assessed. Comorbidities including indications and contraindications for BB use were analyzed.
Of the 366 eligible patients, 156 patients (42.6%) had at least one indication for BB use - of these patients, only 53 (34.0%) were on BB therapy and 61 (39.1%) were not on BB therapy but had no listed contraindication. Prevalent use of BBs at the time of admission in all 366 patients was 19.7%, compared with 45.6%, 39.6% and 45.9% use of anti-platelets, statins and angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers, respectively. CVS and cerebrovascular complications were common in this population (57 patients, 16%) and were associated with longer length of stay (<0.01) and greater inpatient mortality (=0.02).
BBs are under-prescribed in COPD patients despite clear indication(s) for their use. Further work is required to explore barriers to BB prescribing in COPD patients.
心血管（CVS）合并症在慢性阻塞性肺疾病（COPD）中很常见，对发病率和死亡率有重大影响，尤其是在慢性阻塞性肺疾病急性加重期（AECOPD）之后。β受体阻滞剂（BBs）在COPD患者中是安全有效的，在心肌梗死后有生存获益的证据。我们试图确定AECOPD住院患者中BBs的处方是否不足。我们还试图确定CVS和脑血管并发症的住院率及其对患者预后的影响。
收集了12个月期间的回顾性医院数据。分析了所有年龄>40岁且诊断为AECOPD的患者的病历。评估了BBs的普遍使用情况和开始使用情况。分析了包括BBs使用指征和禁忌证在内的合并症。
在366例符合条件的患者中，156例（42.6%）至少有一项使用BBs的指征——在这些患者中，只有53例（34.0%）接受BBs治疗，61例（39.1%）未接受BBs治疗但无列出的禁忌证。在所有366例患者入院时，BBs的普遍使用率为19.7%，而抗血小板药物、他汀类药物和血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂的使用率分别为45.6%、39.6%和45.9%。CVS和脑血管并发症在该人群中很常见（57例，16%），并与住院时间延长（<0.01）和更高的住院死亡率（=0.02）相关。
尽管有明确的使用指征，但COPD患者中BBs的处方不足。需要进一步开展工作以探索COPD患者中BBs处方的障碍。
