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Effect of β-Blockers on Cardiac and Pulmonary Events and Death in Older Adults With Cardiovascular Disease and Chronic Obstructive Pulmonary Disease

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https://ir.library.oregonstate.edu/concern/articles/h702q807g

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  • CONTEXT: In older adults with multiple conditions, medications may not impart the same benefits seen in patients who are younger, or without multi-morbidity. Furthermore, medications given for one condition may adversely affect other outcomes. Beta-blocker (β-Blocker) use with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is such a situation. OBJECTIVE: To determine the effect of β-Blocker use on cardiac and pulmonary outcomes and mortality in older adults with coexisting COPD and CVD. DESIGN, SETTING, PARTICIPANTS: The 1062 participants were members of the 2004-2007 Medicare Current Beneficiary Survey cohorts, a nationally representative sample of Medicare beneficiaries. Study criteria included age 65+ years plus coexisting CVD and COPD/asthma. Follow-up occurred through 2009. We determined the association between β-Blocker use and the outcomes with propensity score-adjusted and covariate-adjusted Cox proportional hazards. MAIN OUTCOME MEASURES: The three outcomes were major cardiac and pulmonary events, and all-cause mortality. RESULTS: Half of the participants used β-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 one or more of these events. The hazard ratio for β-blocker use was 1.18 (95% 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, β-Blockers did not seem to affect occurrence of cardiac or pulmonary events or death in those with CVD and COPD.
  • Keywords: cardiovascular disease, multiple chronic conditions, coronary artery disease, COPD, chronic obstructive pulmonary disease, cardiac events, beta-blocker, pulmonary events, multimorbidity, CAD, CVD
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  • Lee, D. S. H., Markwardt, S., McAvay, G. J., Gross, C. P., Goeres, L. M., Han, L., . . . Tinetti, M. E. (2014). Effect of β-blockers on cardiac and pulmonary events and death in older adults with cardiovascular disease and chronic obstructive pulmonary disease. Medical Care, 52(3), S45-S51. doi:10.1097/MLR.0000000000000035
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  • 52
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  • 3 Supp. 2
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  • Supported by R21HS019446 from the Agency for Healthcare Research and Quality and by the Yale Pepper Center (P30 AG021342) from the National Institute on Aging. D.S.H.L. was funded by training grant T32AG019134 from the National Institute on Aging and the American Society for Clinical Pharmacology New Investigator Award. D.S.H.L. and S.M. were funded by the Oregon Medical Research Foundation New Investigator Grant.
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