Effect of beta-adrenergic receptor blockers on the risk of death in elderly patients with chronic heart failure and chronic obstructive pulmonary disease / 中华老年医学杂志

ABSTRACT

Objective:To analyze the effects of β-receptor blockers on all-cause mortality in elderly patients with mild-moderate chronic heart failure(CHF)and chronic obstructive pulmonary disease(COPD), and to analyze risk factors relevant to death.Methods:This was a multicenter retrospective cohort study from January 2013 to December 2017.The 400 elderly patients with CHF and COPD treated in Rizhao People's Hospital(187 cases), Shandong Provincial Hospital(122 cases)and Beijing Anzhen Hospital(91 cases)were enrolled.The patients receiving β-receptor blockers were included as β-receptor blockers group(n=200), and the patients matching for similar age and cardio-pulmonary function, not receiving β-receptor blockers were selected as the control group(n=200). All patients were followed up until December 31, 2019.The primary endpoints were all-cause mortality.The risk factors for all-cause death were compared and analyzed.Results:Among 400 patients, the average age was(72.2±11.7)years with 226 males(56.5%). There was no significant difference in baseline data such as age, gender ratio, body mass index, heart function, lung function, and treatment regimen after matching between the two groups(all P>0.05). At end of 3-years follow-up, risks of all-cause mortality( χ2=7.284, P<0.01), and re-hospitalization risk due to worsening heart failure( χ2=6.782, P<0.01), acute exacerbation of COPD( χ2=6.921, P<0.01)were significantly reduced in β-receptor blockers group versus control group.Multivariate Cox regression analysis showed that age ≥75 years( HR=2.142), diabetes( HR=1.929), ratio of baseline forced expiratory volume in the first second / forced vital capacity <66.8%( HR=1.114), baseline glomerular filtration rate <72.0 ml/min( HR=3.572)and left ventricular ejection fraction <46.4%( HR=2.294)at end of 3-year follow-up were risk factors for mortality, whileβ-receptor blockers( HR=0.745)was a protective factor(all P<0.05). Conclusions:β-receptor blockers can significantly reduce the mortality and re-hospitalization rate in elderly patients with CHF and COPD.