Effect of β-blockers on cardiac and pulmonary events and death in older adults with cardiovascular disease and chronic obstructive pulmonary disease

TY - JOUR

T1 - Effect of β-blockers on cardiac and pulmonary events and death in older adults with cardiovascular disease and chronic obstructive pulmonary disease

AU - Lee, David S.H.

AU - Markwardt, Sheila

AU - McAvay, Gail J.

AU - Gross, Cary P.

AU - Goeres, Leah M.

AU - Han, Ling

AU - Peduzzi, Peter

AU - Lin, Haiqun

AU - Dodson, John A.

AU - Tinetti, Mary E.

PY - 2014

Y1 - 2014

N2 - Context: In older adults with multiple conditions, medications may not impart the same benefits seen in patients who are younger or without multimorbidity. Furthermore, medications given for one condition may adversely affect other outcomes. b-Blocker use with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is such a situation. Objective: To determine the effect of b-blocker use on cardiac and pulmonary outcomes and mortality in older adults with coexisting COPD and CVD. Design, Setting, Participants: The study included 1062 participants who were members of the 2004-2007 Medicare Current Beneficiary Survey cohorts, a nationally representative sample of Medicare beneficiaries. Study criteria included age over 65 years plus coexisting CVD and COPD/asthma. Follow-up occurred through 2009. We determined the association between b-blocker use and the outcomes with propensity score-adjusted and covariateadjusted Cox proportional hazards. Main Outcome Measures: The 3 outcomes were major cardiac events, pulmonary events, and all-cause mortality. Results: Half of the participants used b-blockers. During follow-up, 179 participants experienced a major cardiac event; 389 participants experienced a major pulmonary event; and 255 participants died. Each participant could have experienced any Z1 of these events. The hazard ratio for b-blocker use was 1.18 [95% confidence interval (CI), 0.85-1.62] for cardiac events, 0.91 (95% CI, 0.73-1.12) for pulmonary events, and 0.87 (95% CI, 0.67-1.13) for death. Conclusion: In this population of older adults, b-blockers did not seem to affect occurrence of cardiac or pulmonary events or death in those with CVD and COPD.

AB - Context: In older adults with multiple conditions, medications may not impart the same benefits seen in patients who are younger or without multimorbidity. Furthermore, medications given for one condition may adversely affect other outcomes. b-Blocker use with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is such a situation. Objective: To determine the effect of b-blocker use on cardiac and pulmonary outcomes and mortality in older adults with coexisting COPD and CVD. Design, Setting, Participants: The study included 1062 participants who were members of the 2004-2007 Medicare Current Beneficiary Survey cohorts, a nationally representative sample of Medicare beneficiaries. Study criteria included age over 65 years plus coexisting CVD and COPD/asthma. Follow-up occurred through 2009. We determined the association between b-blocker use and the outcomes with propensity score-adjusted and covariateadjusted Cox proportional hazards. Main Outcome Measures: The 3 outcomes were major cardiac events, pulmonary events, and all-cause mortality. Results: Half of the participants used b-blockers. During follow-up, 179 participants experienced a major cardiac event; 389 participants experienced a major pulmonary event; and 255 participants died. Each participant could have experienced any Z1 of these events. The hazard ratio for b-blocker use was 1.18 [95% confidence interval (CI), 0.85-1.62] for cardiac events, 0.91 (95% CI, 0.73-1.12) for pulmonary events, and 0.87 (95% CI, 0.67-1.13) for death. Conclusion: In this population of older adults, b-blockers did not seem to affect occurrence of cardiac or pulmonary events or death in those with CVD and COPD.

KW - B-blocker

KW - COPD

KW - CVD

KW - Cardiac events

KW - Cardiovascular disease

KW - Chronic obstructive pulmonary disease

KW - Coronary artery disease

KW - Multimorbidity

KW - Multiple chronic conditions

KW - Pulmonary events

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UR - http://www.scopus.com/inward/citedby.url?scp=84894428063&partnerID=8YFLogxK

U2 - 10.1097/MLR.0000000000000035

DO - 10.1097/MLR.0000000000000035

M3 - Article

C2 - 24561758

SN - 0025-7079

VL - 52

SP - S45-S51

JO - Medical care

JF - Medical care

IS - 3 SUPPL. 2

ER -