Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease: an Italian register-based cohort study
| Autor: | Liberata Sportiello, Annalisa Capuano, Claudia Pagliaro, Magnus T. Jensen, Daniel Bech Rasmussen, Kristian Kragholm, Maurizio Sessa, Francesco Rossi, Morten Andersen, Annamaria Mascolo, Concetta Rafaniello, Giuseppe Michele Tari |
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| Přispěvatelé: | Sessa, M., Mascolo, A., Rasmussen, D. B., Kragholm, K., Jensen, M. T., Sportiello, L., Rafaniello, C., Tari, G. M., Pagliaro, C., Andersen, M., Rossi, F., Capuano, A. |
| Rok vydání: | 2019 |
| Předmět: |
Male
0301 basic medicine Epidemiology lcsh:Medicine Comorbidity Nebivolol Cohort Studies Pulmonary Disease Chronic Obstructive 0302 clinical medicine Registries lcsh:Science Atrioventricular Block Carvedilol Metoprolol Aged 80 and over COPD Multidisciplinary Drug Substitution Hospitalization Italy Bisoprolol Practice Guidelines as Topic Female Interventional cardiology medicine.drug medicine.medical_specialty medicine.drug_class Adrenergic beta-Antagonists Drug Prescriptions Article 03 medical and health sciences Internal medicine medicine Humans Renal Insufficiency Chronic Beta blocker Aged Retrospective Studies Heart Failure business.industry lcsh:R Thrombosis Odds ratio medicine.disease Drug Utilization Cerebrovascular Disorders 030104 developmental biology Heart failure lcsh:Q business 030217 neurology & neurosurgery |
| Zdroj: | Sessa, M, Mascolo, A, Rasmussen, D B, Kragholm, K, Jensen, M T, Sportiello, L, Rafaniello, C, Tari, G M, Pagliaro, C, Andersen, M, Rossi, F & Capuano, A 2019, ' Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease : an Italian register-based cohort study ', Scientific Reports, vol. 9, no. 1, 11465 . https://doi.org/10.1038/s41598-019-47967-y Sessa, M, Mascolo, A, Rasmussen, D B, Kragholm, K, Jensen, M T, Sportiello, L, Rafaniello, C, Tar, G M, Pagliaro, C, Andersen, M, Rossi, F & Capuano, A 2019, ' Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease : an Italian register-based cohort study ', Scientific Reports, vol. 9, no. 1, 11465, pp. 11465 . https://doi.org/10.1038/s41598-019-47967-y Sessa, M, Mascolo, A, Rasmussen, D B, Kragholm, K, Jensen, M T, Sportiello, L, Rafaniello, C, Tari, G M, Pagliaro, C, Andersen, M, Rossi, F & Capuano, A 2019, ' Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease : an Italian register-based cohort study ', Scientific Reports, vol. 9, 11465 . https://doi.org/10.1038/s41598-019-47967-y Scientific Reports Scientific Reports, Vol 9, Iss 1, Pp 1-8 (2019) |
| ISSN: | 2045-2322 |
| DOI: | 10.1038/s41598-019-47967-y |
| Popis: | Clinical guidelines suggest that for patients with heart failure and concurrent chronic obstructive pulmonary disease (COPD), metoprolol/bisoprolol/nebivolol should be preferred over carvedilol. However, studies suggest a high proportion of carvedilol usage that remains unexplained. Therefore, we aimed to investigate the predictors of carvedilol choice in patients with heart failure and COPD that were naïve to carvedilol or metoprolol/bisoprolol/nebivolol. Caserta Local Health Unit databases (Italy) were used as data sources. Age, sex, chronic/acute comorbidities, and co-medications were included in a logistic regression model to assess predictors of carvedilol choice. Chronic comorbidities include those defined in the Elixhauser comorbidity index and all hospitalizations within two years prior to the first beta-blocker prescription. Comedications include all redeemed prescriptions within one year prior to the beta-blocker prescription. Kernel density estimations were used to assess the overlap in propensity and preference scores distributions for receiving carvedilol and thereby potential beta-blocker exchangeability. Totally, 10091 patients composed the study population; 2011 were exposed to carvedilol. The overlapping of propensity scores distributions was 57%. Accordingly, the exchangeability was not reached. Atrioventricular block (Odds Ratio, OR 8.20; 95% Confidence Interval, 95% CI 1.30–51.80), cerebrovascular thrombosis (OR 7.06; 95% CI 1.14–43.68), chronic kidney disease (OR 4.32; 95% CI 1.16–16.02), and acute heart failure (OR 1.97; 95% CI 1.28–3.03) hospitalizations were statistically significantly associated with carvedilol choice. Analogously, human insulin (OR 3.00; 95% CI 1.24–7.24), fondaparinux (OR 2.47; 95% CI 1.17–5.21) or strontium ranelate (OR 2.03; 95% CI 1.06–3.90) redeemed prescriptions. In conclusion, this study suggests the absence of beta-blockers exchangeability and a preferential choice of carvedilol in patients with heart failure, COPD and concurrent chronic kidney disease, atrioventricular block, cerebrovascular thrombosis, acute heart failure or redeeming human insulin, fondaparinux or strontium ranelate prescriptions. Therefore, it suggests that choice of prescribing carvedilol over metoprolol/bisoprolol/nebivolol is driven by differences in comorbidities and co-treatments. |
| Databáze: | OpenAIRE |
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