Association between beta-blocker selectivity and mortality in left heart failure patients with comorbid COPD

Abstract

To evaluate the Impact of posterior to intensive care unit (ICU) beta-blockers use with the clinical outcomes in patients with left heart failure(LHF) and chronic obstructive pulmonary disease(COPD). Patients with LHF and COPD were selected from the Medical Information Mart for Intensive Care IV(MIMIC-IV) database for this retrospective observational study. The primary outcome was 30-day and 365-day all-cause mortality. Comparative survival analysis was performed using Kaplan-Meier estimators to evaluate mortality rates among HF and COPD patients. Hazard ratios (HRs) were calculated to determine the association between post-ICU beta-blockers users and prognosis using Cox proportional hazard models. A total of 3255 patients with LHF complicated by COPD were finally selected. Among them, 2740 patients (84.18%) were treated with beta-blockers, including 1963 patients (60.31%) treated with cardio-selective beta-blockers and 777 patients (23.87%) treated with non-cardio-selective beta-blockers. Kaplan-Meier survival analysis revealed that the 30-day(HR:0.291;95%CI:0.236–0.357; P < 0.001) and 365-day(HR: 0.468; 95%CI: 0.405–0.541; P < 0.001) mortality rates of patients using beta-blockers were significantly lower than those not using beta-blockers, and the mortality rate was even lower in patients using non-selective beta-blockers compared to those using selective beta-blockers, the significance of these findings was consistently observed across all heart failure subtypes comorbid with COPD. Multivariable Cox regression analysis showed that both cardiac-selective and non-selective beta-blocker use were independent predictors of reduced mortality at 30 days (cardiac-selective: HR: 0.239; 95% CI: 0.187–0.304; non-selective: HR: 0.232; 95% CI: 0.163–0.330; both P < 0.001) and 365 days (cardiac-selective: HR: 0.440; 95% CI: 0.371–0.521; non-selective: HR: 0.393; 95% CI: 0.314–0.491; both P < 0.001); after propensity score matching(PSM) of these patients, the above results remained valid. No significant association was observed between beta-blockers dosage and all-cause mortality (all P > 0.05). Our study demonstrates that beta-blockers significantly reduce all-cause mortality in patients with LHF and COPD, an effect particularly associated with non-cardioselective agents. Interestingly, this benefit may depend more on drug class (selectivity) than on dosing intensity.