Effect on Mortality With the Use of Beta Blockers in COPD Patients on Long-Term Oxygen Therapy

Abstract

SESSION TITLE: COPD 3 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality in the United States. Patients with this disease suffer complications from tissue hypoxia and are at increased risk for a variety of hypoxia related comorbid medical conditions including heart disease in the form of coronary artery disease, atrial fibrillation, and congestive heart failure, and patients with these comorbid medical problems face higher mortality rates. However, there is controversy in the literature about the treatment of ischemic heart disease in patients with COPD. Prior studies for the use of beta blockers in patients with COPD including a meta-analysis by Etminan et al. demonstrated an improved mortality rate in patients with the use of these medications, however confounding medical problems and their treatments in patients with COPD may make this data inaccurate. Subsequent studies as with those performed by Ekstrom et al. demonstrated worsening mortality rates on patients using cardiovascular drugs in the setting of patients COPD on long term oxygen therapy, however to date no study has investigated the use of beta blockers in patients with COPD on long-term oxygen therapy. METHODS: This study is a randomized retrospective analysis of patients age 18-95 with a diagnosis of COPD on long term oxygen therapy defined as the need for oxygen supplementation due to a PaO2 of <55mmHg, (O2 sats <88%) on rest or ambulation, or patients with a PaO2 of 55-59 mmHg (O2 sats <89%) and who exhibit signs of tissue hypoxia, between April 2009 to April 2015. This cohort of patients was divided into those who utilized any class of beta blocker (of 6-month duration or more) to those who did not and compares all-cause mortality in both groups as the primary outcome, with hospital readmission rates as a secondary outcome. Patient charts were reviewed to determine the use of and criteria for use of long term oxygen therapy, the use of beta blockers, pulmonary function test results, and the presence or absence of coronary artery disease, atrial fibrillation, and congestive heart failure. A sample size of 383 patients was calculated to produce a 95% confidence interval. RESULTS: 405 patient were identified with COPD on long-term oxygen therapy. Initial results revealed a non-significant increase in all-cause mortality in patients who used beta blockers during the study interval time relative to those who did not with a relative risk of 1.059 and 95% CI of 0.91 to 1.23. The age of death was older in patients who receive beta-blockers with a mean of 82.89 vs 80.92 with a p-value of 0.04. Subgroup analysis for patients with atrial fibrillation, congestive heart failure, and coronary artery disease was performed to determine which patients are most affected by the use of beta blockers. CONCLUSIONS: Beta blocker usage in patients with COPD on long-term oxygen therapy is associated with an older age of death. CLINICAL IMPLICATIONS: Beta blocker usage may be associated with longer lifespan. DISCLOSURE: The following authors have nothing to disclose: John Matera, Shad Mahmood, Shashi Bellam No Product/Research Disclosure Information