Name:
Beta Blocker Therapy
Description:
Beta Blocker Therapy
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/932c519d-a2cd-4312-8e52-94095222e5a7/thumbnails/932c519d-a2cd-4312-8e52-94095222e5a7.jpeg?sv=2019-02-02&sr=c&sig=s6k6kmZ9fM0%2Byad1L8KjwJneMneMUc%2B92uzgvw6aZ%2B8%3D&st=2024-12-22T06%3A15%3A49Z&se=2024-12-22T10%3A20%3A49Z&sp=r
Duration:
T00H05M02S
Embed URL:
https://stream.cadmore.media/player/932c519d-a2cd-4312-8e52-94095222e5a7
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/932c519d-a2cd-4312-8e52-94095222e5a7/18778984.mp3?sv=2019-02-02&sr=c&sig=d28c7gswT%2F1GXRnsfB4fnqpews5f7B941VGNti1EN0M%3D&st=2024-12-22T06%3A15%3A49Z&se=2024-12-22T08%3A20%3A49Z&sp=r
Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's, The Heart Board Review, and other online resources available only through accesscardiology.com. >> Cardiovascular disease and COPD, chronic obstructive lung disease, in patients has led to, you know, poor outcomes, and it does really represent challenges. And so, I did want to present a new study -- actually, two studies that addressed the issue of COPD and beta-blockers, as well as COPD, cardiovascular disease, and beta-blocker treatment.
[ Music ] Hi, I'm Dr. Bernie, and welcome to Practice Impact Extra. Treating patients with cardiovascular disease and COPD is a difficult everyday problem, and the balance of doing good and doing no harm is one that creates significant clinician anxiety. Until recently, observational data has been somewhat insufficient regarding beta-blocker therapy in patients with COPD.
So, I wanted to present the BLOCK-COPD trial. This was beta-blockers for the prevention of acute exacerbation of COPD. This was published in December of 2020 in the New England Journal of Medicine. The methods of this trial was a design which was prospective and randomized of 532 patients with COPD and at an increased risk of exacerbation. Patients without, let me repeat, patient without an indication for beta-blockers, either received metoprolol extended release or placebo and were followed up for nearly 1 year.
The primary endpoint of the BLOCK-COPD trial was the time to the first exacerbation of COPD in the treatment period. What were the results? There was no significant difference between the two groups in median time to first exacerbation. However, the metoprolol group was associated with a higher risk of exacerbation leading to hospitalization. There were 11 deaths in the metoprolol group and 5 in the placebo group. They also concluded that treatment with beta-blockers did not increase the time to first exacerbation, though it was associated with more hospitalization, particularly in the moderate to severe COPD group who did not have an indication for beta-blockers.
We know, however, that the guidelines recommend beta-blockers to be given to patients with myocardial infarction and heart failure to improve outcomes, but there are many patients with COPD and CVD. Is there any trial evidence that adding beta-blocker therapy improves survival in this cohort of patients who have CVD and COPD? In November 2020 in the European Heart Journal, a systematic review and meta-analysis was published evaluating the effects of beta-blockers in patients with COPD and CVD.
For its methods, there were a total of 49 studies, 12 were randomized clinical trials, 37 were cohort or case control studies, and this comprised 670,574 patients. The outcome measures included COPD exacerbation, all-cause mortality, and in-hospital mortality. What were the results? Of the 20 -- the beta-blockers were associated with a lower risk of COPD exacerbation, which was primarily driven by a reduced risk when the beta-blocker was of a cardioselective type.
Beta-blockers had no significant impact either on pulmonary function tests. Twenty-two studies examined all-cause mortality. Beta-blockers were associated with significant reduced risk. If you did a subgroup analysis of those patients, those with heart failure and MI had the same similar good outcome. Beta-blockers were associated with a reduced risk of in-hospital mortality in 5 studies. What's my perspective? I think this meta-analysis offers reassurance that patients with COPD and CVD who have indications for beta-blocker treatment should be treated according to the present guidelines.
The use of cardioselective beta-blocker meds seems to be the prudent choice. Clearly, careful and personalized treatment and close monitoring and follow-up is mandatory in this increased patient population. Thank you for joining me and see you next time on Practice Impact Extra. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features.
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