Maurizio Sessa1,2, Annamaria Mascolo1, Rikke Nørmark Mortensen2, Mikkel Porsborg Andersen3, Giuseppe Massimo Claudio Rosano4,5, Annalisa Capuano1, Francesco Rossi1, Gunnar Gislason6,7,8, Henrik Enghusen-Poulsen9, Christian Torp-Pedersen2,3. 1. Department of Experimental Medicine, Section of Pharmacology 'L. Donatelli', University of Campania 'L. Vanvitelli', Naples, Italy. 2. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark. 3. Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. 4. San Raffaele Pisana Hospital IRCCS, Rome, Italy. 5. Cardiovascular and Cell Sciences Research Institute, St. George's University of London, London, UK. 6. Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark. 7. The Danish Heart Foundation, Copenhagen K, Copenhagen, Denmark. 8. The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. 9. Laboratory of Clinical Pharmacology, Rigshospitalet, Copenhagen, Denmark.
Abstract
AIMS: To compare the hazard of all-cause, chronic obstructive pulmonary disease (COPD) and heart failure (HF) hospitalization in carvedilol vs. metoprolol/bisoprolol/nebivolol users with COPD and concurrent HF from 2009 to 2012, and to evaluate the use and persistence in treatment of these β-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 significant differences were found for all-cause and COPD hospitalization between the two groups. Carvedilol users had a 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 that observed in 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 prescription 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 prescription at variance with the European Society of Cardiology guidelines and potential for improving the proportion of patients treated with β-blockers.
RCT Entities:
AIMS: To compare the hazard of all-cause, chronic obstructive pulmonary disease (COPD) and heart failure (HF) hospitalization in carvedilol vs. metoprolol/bisoprolol/nebivolol users with COPD and concurrent HF from 2009 to 2012, and to evaluate the use and persistence in treatment of these β-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 significant differences were found for all-cause and COPD hospitalization between the two groups. Carvedilol users had a 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 that observed in 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 prescription 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 prescription at variance with the European Society of Cardiology guidelines and potential for improving the proportion of patients treated with β-blockers.
Authors: Catherine N Marti; Gregg C Fonarow; Stefan D Anker; Clyde Yancy; Muthiah Vaduganathan; Stephen J Greene; Ali Ahmed; James L Januzzi; Mihai Gheorghiade; Gerasimos Filippatos; Javed Butler Journal: Eur J Heart Fail Date: 2018-12-10 Impact factor: 15.534
Authors: Konstantinos Kostikas; Chin Kook Rhee; John R Hurst; Piergiuseppe Agostoni; Hui Cao; Robert Fogel; Rupert Jones; Janwillem W H Kocks; Karen Mezzi; Simon Wan Yau Ming; Ronan Ryan; David B Price Journal: Pragmat Obs Res Date: 2020-06-02