Arcoraci Vincenzo, Squadrito Francesco, Rottura Michelangelo, Barbieri Maria Antonietta, Pallio Giovanni, Irrera Natasha, Nobili Alessandro, Natoli Giuseppe, Argano Christiano, Squadrito Giovanni, Corrao Salvatore
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
SunNutraPharma, Academic Spin-Off Company of the University of Messina, Messina, Italy.
Front Cardiovasc Med. 2022 May 16;9:876693. doi: 10.3389/fcvm.2022.876693. eCollection 2022.
Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations.
β受体阻滞剂（BB）有助于降低心力衰竭（HF）合并慢性阻塞性肺疾病（COPD）患者的发病率和死亡率。然而，使用BB可能会因β2受体阻滞而诱发支气管收缩。因此，欧洲心脏病学会（ESC）和慢性阻塞性肺疾病全球倡议（GOLD）指南均强烈建议在HF和COPD患者中使用选择性β1受体阻滞剂。然而，在多个临床环境中都观察到对指南的依从性较低。本研究的目的是调查REPOSI登记册中记录的老年HF和COPD患者使用BB的情况。在942例HF患者中，47.1%接受了BB治疗。HF合并COPD患者在入院时和出院时使用BB的比例均显著低于单纯HF患者（入院时，36.9%对51.3%；出院时，38.0%对51.7%）。此外，出院时未发现更多使用BB的患者。合并COPD的HF患者接受BB治疗的概率显著较低（校正后比值比，95%置信区间：0.50，0.37 - 0.67），而COPD的诊断与选择性β1受体阻滞剂的选择无关（校正后比值比，95%置信区间：1.33，0.76 - 2.34）。尽管临床指南有明确建议，但出院后仍观察到BB的使用明显不足。在COPD患者中，医生不合理地拒绝使用BB，而不是选择β1受体阻滞剂。未观察到住院后BB处方预期的改善情况。医院医生、全科医生和药理学家之间应采取多学科方法，以实现更好的药物管理并遵循指南建议。
