Read the full paper here: www.bmj.com/content/347/bmj.f6650
A population based cohort study of UK electronic healthcare records.
Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular comorbidities, including myocardial infarction and have decreased short and long term survival after a myocardial infarction compared with patients without COPD. COPD is currently the fourth leading cause of death in the United States and Europe and is predicted to become the third by 2020. Up to a third of deaths in patients with COPD are attributable to cardiovascular disease and for every 10% decrease in forced expiratory volume in one second (FEV1), cardiovascular mortality increases by 28%. While it is likely that COPD itself contributes to an underlying increase in mortality after myocardial infarction, there could be some potentially modifiable risk factors.
β blockers are effective at reducing risk of mortality and re-infarction after myocardial infarction, and they might reduce mortality in patients with COPD with acute coronary syndromes. Despite increasing evidence that β blockers are safe and can actually be beneficial in patients with COPD, even beyond cardiovascular properties, their use continues to be limited in this group. This is a worldwide phenomenon and might be related to historical concerns that β blockers could be harmful in patients with COPD (for example, by inducing bronchospasm). Such concerns, however, have been challenged by recent evidence. Cardioselective β blockers are less likely to cause bronchospasm, and, additionally, the risk of bronchospasm can be reduced by starting β blockers at a lower dose and slowly titrating up.
Using linked Myocardial Ischaemia National Audit Project data (MINAP) and General Practice Research Database (GPRD) data, we aimed to quantify the association between COPD and mortality after myocardial infarction to investigate whether the use and timing of prescription of β blockers in patients with COPD after a first myocardial infarction was associated with improved survival, and to identify factors related to the use of β blockers in with COPD.
