(271) Comparative Safety of Beta-Blocker and Calcium Channel Blockers in Patients with Chronic Obstructive Pulmonary Disease and Atrial Fibrillation: A National Population Cohort Study in Taiwan

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 602

Presenting Author(s)

Shan-Ju Lin
– NCKU Institute of Clinical Pharmacy and Pharmaceutical Sciences, Tainan, Tainan, Taiwan

Co-Author(s)

Nai-Yu Chen
– NCKU Institute of Clinical Pharmacy and Pharmaceutical Sciences, Tainan, Taiwan
Yu-Ching Chang
– Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)
Ching-Lan Cheng
– School of Pharmacy and, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)

Background: Previous studies had established the benefits and safety of beta-blocker (BB) in chronic obstructive pulmonary disease (COPD)patients with myocardial infarction (MI) or congestive heart failure (CHF). However, safety of beta-blockers used in COPD patients with atrial fibrillation (AF) was still controversial.

Objectives: To evaluate the real-world comparative risk of beta-blockers and non-dihydropyridine calcium channel blockers (CCB) for patients with COPD and AF.

Methods: We conducted a retrospective cohort study using the National Health Insurance Database from 2009-2018. Patients with prevalent COPD and incident AF were enrolled in this study. We divided patients into BB or CCB group based on the first prescription (the date was index date) after the first AF diagnosis and excluded patients received both BB and CCB. The primary outcome was all-cause mortality, and secondary outcome was emergency room visit or hospitalization due to COPD with acute exacerbation (COPDAE). We collected baseline characteristic 1-year before index date and presented as mean (standard deviation, SD) or number (percentage). We applied Kaplan-Meier method to estimate cumulative incidence rate and log-rank test to determine the difference. Finally, we used cox-proportional hazard model to calculate the hazard ratio (HR) and 95% confidence interval (CI).

Results: Total 41523 patients were enrolled in this study, 22598 in BB group (54.4%) and 18925 in CCB group (45.6%). We found 57.1% patients received selective BB in BB group. From baseline characteristic, the history of CHF, MI and ischemic heart disease (IHD) were respectively 43.2%, 7.9%, and 45.5% in BB group and 41.9%, 4.9% and 38.8% in CCB group. During 1 year before index date, 10.5% in BB group and 17% in CCB group had at least 1 episode of COPDAE, whereas 2.5% in BB group and 7.1% in CCB group occurred three times and above. After 1-year follow-up, the mortality was 23% in BB group and 34% in CCB group Log-rank test also showed significant difference for 2 groups in mortality and COPDAE. Finally, compared with CCB group, BB group was associated with a lower risk of mortality (adjusted HR=0.86; 95% CI 0.83-0.88) and lower risk of COPDAE (adjusted HR=0.68; 95% CI 0.65-0.71). Moreover, we applied several subgroup analyses and found that either selective BB or non-selective BB had a lower risk of mortality and COPDAE. We also found that regardless of patient with CHF and MI or not, the risk was lower in BB group.

Conclusions: The use of BB in patients with COPD and AF associated with a lower risk of mortality and COPDAE compared with use of CCB. The association was independent of the selectivity of BB, presence or absence of CHF and MI. In further studies, subgroup analysis of severe COPD cases and other sensitivity analysis are needed.