Abstract
Aims
To compare the hazard of all-cause, chronic obstructive pulmonary disease (COPD), and heart failure (HF) hospitalizations between carvedilol and metoprolol/bisoprolol/nebivolol users with COPD and concurrent HF from 2009-2012, and to evaluate the use of and persistence in treatment with these beta blockers, their impact on the risk of COPD-related hospitalization, and the factors important for their selection.
Methods and results
Cox and logistic regression were used for both unadjusted and adjusted analyses. Carvedilol users had a higher hazard of being hospitalized for HF compared with metoprolol/bisoprolol/nebivolol users in both the unadjusted (hazard ratio [HR] 1.74; 95% confidence interval [CI] 1.65-1.83) and adjusted (HR 1.61; 95%CI 1.52-1.70) analyses. No statistically significant differences were found for all-cause and COPD hospitalization between the two groups. Carvedilol users had a statistically significant lower restricted mean persistence time than metoprolol/bisoprolol/nebivolol users. Patients exposed to carvedilol had an odds ratio (OR) of 1.38 (95%CI 1.23-1.56) for being hospitalized due to COPD within 60 days after redeeming the first carvedilol prescription which was similar to those observed for metoprolol/bisoprolol/nebivolol users (OR 1.37; 95%CI 1.27-1.48). Patients with concurrent chronic kidney disease had a higher probability of receiving carvedilol (OR 1.16; 95%CI 1.04-1.29).
Conclusion
Carvedilol prescriptions carried an increased hazard of HF hospitalization and lower restricted mean persistence time among patients with COPD and concurrent HF. Additionally, we found a widespread phenomenon of carvedilol prescriptions at variance with ESC guidelines and potential for improving the proportion of patients treated with beta-blockers.
