Beta-blocker, aspirin and statin usage after first-time myocardial infarction in patients with chronic obstructive pulmonary disease

a nationwide analysis from 1995 to 2015 in Denmark

Daniel Bech Rasmussen*, Uffe Bodtger, Morten Lamberts, Sia Kromann Nicolaisen, Maurizio Sessa, Annalisa Capuano, Christian Torp-Pedersen, Gunnar Gislason, Peter Lange, Magnus Thorsten Jensen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Aims: To determine whether beta-blockers, aspirin, and statins are underutilized after first-time myocardial infarction (MI)in patients with chronic obstructive pulmonary disease (COPD) compared with patients without COPD. Further, todetermine temporal trends, and risk factors for non-use.

Methods and Results: Using Danish nationwide registers, we performed a cross-sectional study investigating the utilization of betablockers, aspirin and statins after hospitalisation for first-time MI among patients with and without COPD from 1995to 2015. Risk factors for non-use were examined in multivariable logistic regression models. During 21 years of study, 140,278 patients were included, hereof 13,496 (9.6%) with COPD. Patients with COPD were less likely to use beta-blockers (53.2% vs. 76.2%, P < 0.001), aspirin (73.9% vs. 78.8%, P < 0.001), and statins (53.5% vs. 61.9%, P < 0.001). Medication usage increased during the study period but inmultivariable analyses, COPD remained a significant predictor for non-use: OR [95% CI] for non-use of betablockers 1.86 [1.76-1.97]; aspirin 1.24 [1.16-1.32]; statins 1.50 [1.41-1.59]. Analyses stratified by ST-segmentelevation myocardial infarction (STEMI) and non-STEMI showed similar undertreatment of COPD patients. Risk factors for non-use of beta-blockers in COPD included increasing age, female sex, andincreasing severity of COPD (frequent exacerbations, use of multiple inhaled medications, low lung function). Similar findings were demonstrated for aspirin and statins.

Conclusion: Beta-blockers, and to a lesser extent aspirin and statins, were systematically underutilized by patients with COPD following hospitalisation for MI despite an overall increase in the utilization over time. Increasing severity of COPDwas a risk factor for non-use of the medications.

Original languageEnglish
JournalEuropean heart journal. Quality of care & clinical outcomes
ISSN2058-1742
DOIs
Publication statusE-pub ahead of print - 4. Jan 2019

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Denmark
Chronic Obstructive Pulmonary Disease
Logistic Models
Cross-Sectional Studies

Keywords

  • Chronic obstructive pulmonary disease (COPD)
  • Treatment
  • Multimorbidity

Cite this

Rasmussen, Daniel Bech ; Bodtger, Uffe ; Lamberts, Morten ; Nicolaisen, Sia Kromann ; Sessa, Maurizio ; Capuano, Annalisa ; Torp-Pedersen, Christian ; Gislason, Gunnar ; Lange, Peter ; Jensen, Magnus Thorsten. / Beta-blocker, aspirin and statin usage after first-time myocardial infarction in patients with chronic obstructive pulmonary disease : a nationwide analysis from 1995 to 2015 in Denmark. In: European heart journal. Quality of care & clinical outcomes. 2019.
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title = "Beta-blocker, aspirin and statin usage after first-time myocardial infarction in patients with chronic obstructive pulmonary disease: a nationwide analysis from 1995 to 2015 in Denmark",
abstract = "Aims: To determine whether beta-blockers, aspirin, and statins are underutilized after first-time myocardial infarction (MI)in patients with chronic obstructive pulmonary disease (COPD) compared with patients without COPD. Further, todetermine temporal trends, and risk factors for non-use.Methods and Results: Using Danish nationwide registers, we performed a cross-sectional study investigating the utilization of betablockers, aspirin and statins after hospitalisation for first-time MI among patients with and without COPD from 1995to 2015. Risk factors for non-use were examined in multivariable logistic regression models. During 21 years of study, 140,278 patients were included, hereof 13,496 (9.6{\%}) with COPD. Patients with COPD were less likely to use beta-blockers (53.2{\%} vs. 76.2{\%}, P < 0.001), aspirin (73.9{\%} vs. 78.8{\%}, P < 0.001), and statins (53.5{\%} vs. 61.9{\%}, P < 0.001). Medication usage increased during the study period but inmultivariable analyses, COPD remained a significant predictor for non-use: OR [95{\%} CI] for non-use of betablockers 1.86 [1.76-1.97]; aspirin 1.24 [1.16-1.32]; statins 1.50 [1.41-1.59]. Analyses stratified by ST-segmentelevation myocardial infarction (STEMI) and non-STEMI showed similar undertreatment of COPD patients. Risk factors for non-use of beta-blockers in COPD included increasing age, female sex, andincreasing severity of COPD (frequent exacerbations, use of multiple inhaled medications, low lung function). Similar findings were demonstrated for aspirin and statins.Conclusion: Beta-blockers, and to a lesser extent aspirin and statins, were systematically underutilized by patients with COPD following hospitalisation for MI despite an overall increase in the utilization over time. Increasing severity of COPDwas a risk factor for non-use of the medications.",
keywords = "Chronic obstructive pulmonary disease (COPD), Treatment, Multimorbidity",
author = "Rasmussen, {Daniel Bech} and Uffe Bodtger and Morten Lamberts and Nicolaisen, {Sia Kromann} and Maurizio Sessa and Annalisa Capuano and Christian Torp-Pedersen and Gunnar Gislason and Peter Lange and Jensen, {Magnus Thorsten}",
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Beta-blocker, aspirin and statin usage after first-time myocardial infarction in patients with chronic obstructive pulmonary disease : a nationwide analysis from 1995 to 2015 in Denmark. / Rasmussen, Daniel Bech; Bodtger, Uffe; Lamberts, Morten; Nicolaisen, Sia Kromann; Sessa, Maurizio; Capuano, Annalisa; Torp-Pedersen, Christian; Gislason, Gunnar; Lange, Peter; Jensen, Magnus Thorsten.

In: European heart journal. Quality of care & clinical outcomes, 04.01.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Beta-blocker, aspirin and statin usage after first-time myocardial infarction in patients with chronic obstructive pulmonary disease

T2 - a nationwide analysis from 1995 to 2015 in Denmark

AU - Rasmussen, Daniel Bech

AU - Bodtger, Uffe

AU - Lamberts, Morten

AU - Nicolaisen, Sia Kromann

AU - Sessa, Maurizio

AU - Capuano, Annalisa

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

AU - Lange, Peter

AU - Jensen, Magnus Thorsten

N1 - E-pub.

PY - 2019/1/4

Y1 - 2019/1/4

N2 - Aims: To determine whether beta-blockers, aspirin, and statins are underutilized after first-time myocardial infarction (MI)in patients with chronic obstructive pulmonary disease (COPD) compared with patients without COPD. Further, todetermine temporal trends, and risk factors for non-use.Methods and Results: Using Danish nationwide registers, we performed a cross-sectional study investigating the utilization of betablockers, aspirin and statins after hospitalisation for first-time MI among patients with and without COPD from 1995to 2015. Risk factors for non-use were examined in multivariable logistic regression models. During 21 years of study, 140,278 patients were included, hereof 13,496 (9.6%) with COPD. Patients with COPD were less likely to use beta-blockers (53.2% vs. 76.2%, P < 0.001), aspirin (73.9% vs. 78.8%, P < 0.001), and statins (53.5% vs. 61.9%, P < 0.001). Medication usage increased during the study period but inmultivariable analyses, COPD remained a significant predictor for non-use: OR [95% CI] for non-use of betablockers 1.86 [1.76-1.97]; aspirin 1.24 [1.16-1.32]; statins 1.50 [1.41-1.59]. Analyses stratified by ST-segmentelevation myocardial infarction (STEMI) and non-STEMI showed similar undertreatment of COPD patients. Risk factors for non-use of beta-blockers in COPD included increasing age, female sex, andincreasing severity of COPD (frequent exacerbations, use of multiple inhaled medications, low lung function). Similar findings were demonstrated for aspirin and statins.Conclusion: Beta-blockers, and to a lesser extent aspirin and statins, were systematically underutilized by patients with COPD following hospitalisation for MI despite an overall increase in the utilization over time. Increasing severity of COPDwas a risk factor for non-use of the medications.

AB - Aims: To determine whether beta-blockers, aspirin, and statins are underutilized after first-time myocardial infarction (MI)in patients with chronic obstructive pulmonary disease (COPD) compared with patients without COPD. Further, todetermine temporal trends, and risk factors for non-use.Methods and Results: Using Danish nationwide registers, we performed a cross-sectional study investigating the utilization of betablockers, aspirin and statins after hospitalisation for first-time MI among patients with and without COPD from 1995to 2015. Risk factors for non-use were examined in multivariable logistic regression models. During 21 years of study, 140,278 patients were included, hereof 13,496 (9.6%) with COPD. Patients with COPD were less likely to use beta-blockers (53.2% vs. 76.2%, P < 0.001), aspirin (73.9% vs. 78.8%, P < 0.001), and statins (53.5% vs. 61.9%, P < 0.001). Medication usage increased during the study period but inmultivariable analyses, COPD remained a significant predictor for non-use: OR [95% CI] for non-use of betablockers 1.86 [1.76-1.97]; aspirin 1.24 [1.16-1.32]; statins 1.50 [1.41-1.59]. Analyses stratified by ST-segmentelevation myocardial infarction (STEMI) and non-STEMI showed similar undertreatment of COPD patients. Risk factors for non-use of beta-blockers in COPD included increasing age, female sex, andincreasing severity of COPD (frequent exacerbations, use of multiple inhaled medications, low lung function). Similar findings were demonstrated for aspirin and statins.Conclusion: Beta-blockers, and to a lesser extent aspirin and statins, were systematically underutilized by patients with COPD following hospitalisation for MI despite an overall increase in the utilization over time. Increasing severity of COPDwas a risk factor for non-use of the medications.

KW - Chronic obstructive pulmonary disease (COPD)

KW - Treatment

KW - Multimorbidity

U2 - 10.1093/ehjqcco/qcy063

DO - 10.1093/ehjqcco/qcy063

M3 - Journal article

JO - European heart journal. Quality of care & clinical outcomes

JF - European heart journal. Quality of care & clinical outcomes

SN - 2058-1742

ER -