Beta-blockers are associated with reduced mortality in patients with COPD undergoing vascular surgery

Key Points

An observational retrospective study published in the American Journal of Respiratory and Critical Care Medicine demonstrated that mortality is reduced when patients with chronic obstructive pulmonary disease (COPD) are treated with cardioselective beta-blockers before major vascular surgery.

The study, conducted at the Erasmus Medical Center, Rotterdam, the Netherlands, evaluated 3,371 consecutive patients (73% male; mean age, 66±12 y) who underwent major vascular surgery between 1990 and 2006. Patients were diagnosed with COPD based on postbronchodilator spirometric measures and a history of cough, sputum production, and/or dyspnea. The primary study end points were short-term (30-d) and long-term survival. The secondary end point was the association between beta-blocker dosage (low or intensified) and mortality. A total of 96% of the study patients had a median follow-up of 5 years.

Investigators identified a total of 1,265 patients with COPD. Of these, 462 were treated with beta-blockers, including bisoprolol, metoprolol, and atenolol. Within 30 days of surgery, 16 patients with COPD who were treated with beta-blockers (4%) died compared with 66 patients with COPD who were not treated with beta-blockers (8%; P=.001). Long-term mortality was also reduced in patients with COPD who received beta-blockers (n=184 [40%]) versus those with COPD who did not (n=532 [67%]; P<.001). Overall, in patients with COPD receiving beta-blockers, both 30-day (OR=0.37; 95% CI, 0.19–0.72) and long-term (HR=0.73; 95% CI, 0.60–0.88) mortality were reduced compared with patients who did not receive beta-blockers.

The authors discussed several limitations of their study. They pointed out the possibility that study patients with COPD also might have had undiagnosed asthma, which could have affected the results. Additionally, because this was not a clinical trial but an observational study, the results may have been affected by confounding. The authors also reported that prescriptions for beta-blockers increased during the 10 years of follow-up; to minimize this potential bias, the authors adjusted for year of surgery.

The authors concluded that beta-blockers can be used safely in carefully selected patients with COPD who are undergoing vascular surgery, although these patients should be monitored closely for adverse effects.

SOURCE

van Gestle YRBM, Hoeks SE, Sin DD, et al. Impact of cardioselective beta-blockers on mortality in patients with chronic obstructive pulmonary disease and atherosclerosis. Am J Respir Crit Care Med. 2008;178:695–700.