Abstract
BACKGROUND: Beta-blockers (BBs) are a cornerstone of the management of cardiovascular diseases (CVD) such as heart failure with reduced ejection fraction (HFrEF), acute myocardial infarction (AMI), and atrial fibrillation (AF). Their use in patients with co-existing chronic obstructive pulmonary disease (COPD) remains controversial due to concerns about potential bronchoconstriction and respiratory side effects. This study aimed to assess the safety and effectiveness of BBs in patients with COPD and co-existing cardiovascular conditions using real-world data. METHODS: We conducted a retrospective, propensity score-matched analysis using the TriNetX global federated research network. Patients with a diagnosis of both COPD and CVD (HFrEF, AMI, or AF) between January 2010 and January 2023 were included. Outcomes assessed over a one-year follow-up included all-cause mortality (primary outcome), emergency admissions (EA), and acute exacerbations of COPD (AECOPD). Subgroup analyses were conducted based on cardiovascular indication, BB selectivity, sex, and age group. RESULTS: A total of 394,476 patients were included; 241,837 were BB users and 152,639 were non-users. After propensity score matching (n = 103,249 per group), there was no significant difference in mortality (HR: 0.98, 95% CI: 0.94-1.02). BB use was associated with an increased risk of EA (HR: 1.30, 95% CI: 1.22-1.40) and a modest increase in AECOPD (HR: 1.03, 95% CI: 1.02-1.04). Findings were consistent across subgroups. CONCLUSION: In people with COPD and a cardiac indication for BB use, the use of BBs was not associated with mortality benefit but was associated with a modest increased risk of AECOPD and a pronounced risk of increased EA. CLINICAL TRIAL REGISTRATION: Not applicable. This study is not a clinical trial; therefore, no trial registry, registration number, or registration date is required.