Original Article

Frequency of β-Blocker Use Following Exacerbations of COPD in Patients with Compelling Indication for Use

Authors: Nathan Pinner, PharmD, Wesley Oliver, PharmD, MS, Tara Veasey,mD, Jessica Starr, PharmD, Sarah Eudaley, PharmD, Amber Hutchison, PharmD, Kurt Wargo, PharmD


Objective: To assess the current use of β-blockers in patients with compelling indications for use, following the acute exacerbation of chronic obstructive pulmonary disease (COPD).

Methods: We performed a multicenter retrospective observational study using data from all of the patients admitted to five institutions for an acute exacerbation of COPD. Patients were included if they were admitted for an acute exacerbation of COPD and had a compelling indication for the use of a β-blocker, defined as previous myocardial infarction or heart failure with left ventricular ejection fraction ≤40%.

Results: There were 396 patients meeting the criteria for inclusion in the study. The population was predominantly white men with myocardial infarction as the most prevalent compelling indication. On admission, 267 (67.4%) patients were receiving β-blockers, which increased to 278 (70.2%) at discharge. There were 118 (29.8%) patients discharged without β-blockers. Of the predictors tested, none were significantly predictive of a patient not receiving β-blockers upon discharge; however, home and in-hospital β-blockers reduced the likelihood of being discharged without a β-blocker. Of the 129 patients not receiving β-blockers prehospitalization, 23 (17.8%) were discharged with a new prescription for a β-blocker.

Conclusions: Nearly one-third of patients with compelling indications for β-blockers were not prescribed the therapy at discharge.
Posted in: Pulmonary Disease3

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. National Heart, Lung, and Blood Institute. Morbidity and mortality: 2012 chartbook on cardiovascular, lung and blood diseases. https://www.nhlbi.nih.gov/files/docs/research/2012_ChartBook_508.pdf. Published 2012. Accessed September 14, 2019.
2. World Health Organization. The top 10 causes of death 2016. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed October 10, 2019.
3. Soriano JB, Visick GT, Muellerova H, et al. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest 2005;128:2099-2107.
4. Fabbri LM, Luppi F, Beghé B, et al. Complex chronic comorbidities of COPD. Eur Respir J 2008;31:204-212.
5. Global Initiative for Chronic Obstructive Lung Disease. GOLD 2017 global strategy for the diagnosis, management and prevention of COPD. https://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd. Published 2017. Accessed September 14, 2019.
6. Mannino DM, Gagnon RC, Petty TL, et al. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2000;160:1683-1689.
7. US Surgeon General. The Health Consequences of Smoking: A Report of the Surgeon General. Washington, DC:Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health;2004.
8. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33:1165-85.
9. Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 2003;107:1514-1519.
10. Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007;356:775-789.
11. Lindenfeld J, Albert NM, Heart Failure Society of America.et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail 2010;16:e1-e194.
12. Smith SC, Jr Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 2011;124:2458-2473.
13. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;128:e240-e327.
14. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001;357:1385-1390.
15. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999;353:2001-2007.
16. Freemantle N, Cleland J, Young P, et al. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999;318:1730-1737.
17. Packer M, Fowler MB, Roecker EB, et al. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation 2002;106:2194-2199.
18. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998;339:489-497.
19. Viskin S, Barron HV. Beta blockers prevent cardiac death following a myocardial infarction: so why so many infarct survivors discharged without beta blockers? Am J Cardiol 1996;78:821-822.
20. Egred M, Shaw S, Mohammad B, et al. Under-use of beta-blockers in patients with ischaemic heart disease and concomitant chronic obstructive pulmonary disease. QJM 2005;98:493-497.
21. Olenchock BA, Fonarow GG, Pan W, et al. Current use of beta blockers in patients with reactive airway disease who are hospitalized with acute coronary syndromes. Am J Cardiol 2009;103:295-300.
22. Mentz RJ, Schmidt PH, Kwansny MJ, et al. The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. J Card Fail 2012;18:551-523.
23. Mentz RJ, Schulte PJ, Fleg JL, et al. Clinical characteristics, response to exercise training, and outcomes in patients with heart failure and chronic obstructive pulmonary disease: findings from Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION). Am Heart J 2013;165:193-199.
24. van der Woude HJ, Zaagsma J, Postma DS, et al. Detrimental effects of beta-blockers in COPD: a concern for nonselective beta-blockers. Chest 2005;127:818-824.
25. Chang CL, Mills GD, McLachlan JD, et al. Cardio-selective and non-selective beta-blockers in chronic obstructive pulmonary disease: effects on bronchodilator response and exercise. Intern Med J 2010;193-200.
26. Salpeter SR, Ormiston TM, Salpeter EE. Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005;4:CD003566.
27. Dransfield MT, Rowe SM, Johnson JE, et al. Use of beta blockers and the risk of death in hospitalised patients with acute exacerbations of COPD. Thorax 2008;63:301-305.
28. Rutten FH, Zuithoff NPA, Hak E, et al. Beta-blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease. Arch Intern Med 2010;170:880-887.
29. Short PM, Lipworth SW, Elder DH, et al. Effect of β blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study. BMJ 2011;342 :d2549.
30. Etminan M, Jafari S, Carleton B, et al. Beta-blocker use and COPD mortality: a systematic review and meta-analysis. BMC Pulm Med 2012;12:48.
31. Farland MZ, Peters CJ, Williams JD, et al. β-Blocker use and incidence of chronic obstructive pulmonary disease exacerbations. Ann Pharmacother 2013;47:651-656.
32. Andell P, Erlinge D, Smith JG, et al. β-blocker use and mortality in COPD patients after myocardial infarction: a Swedish nationwide observational study. J Am Heart Assoc 2015;4:e001611.
33. Stefan MS, Bannuru RR, Lessard D, et al. The impact of COPD on management and outcomes of patients hospitalized with acute myocardial infarction. Chest 2012;141:1441-1448.
34. O'Connor PJ, Sperl-Hillen JA, Johnson PE, et al. Clinical inertia and outpatient medical errors. In: Henriksen K, Battles JB, Marks ES, et al. , eds. Advances in Patient Safety: From Research to Implementation. Volume 2: Concepts and Methodology. Rockville, MD:Agency for Healthcare Research and Quality;2005.
35. Gardner B, Graner K. Pharmacists’ medication reconciliation-related clinical interventions in a children’ hospital. Jt Comm J Qual Patient Saf 2009;35:278-282.
36. Mekonnen AB, McLachlan AJ, Brien JA. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther 2016;41:128-144.
37. Boockvar KS, Santos SL, Kushniruk A, et al. Medication reconciliation: barriers and facilitators from the perspectives of resident physicians and pharmacists. J Hosp Med 2011;6:329-337.
38. Rozich JD, Howard RJ, Justeson JM, et al. Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf 2004;30:5-14.