Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease

an Italian register-based cohort study

Maurizio Sessa*, Annamaria Mascolo, Daniel Bech Rasmussen, Kristian Kragholm, Magnus Thorsten Jensen, Liberata Sportiello, Concetta Rafaniello, Giuseppe Michele Tari, Claudia Pagliaro, Morten Andersen, Francesco Rossi, Annalisa Capuano

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

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.

Original languageEnglish
Article number11465
JournalScientific Reports
Volume9
Number of pages8
ISSN2045-2322
DOIs
Publication statusPublished - 1. Dec 2019

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Chronic Obstructive Pulmonary Disease
Cohort Studies
Nebivolol
Prescriptions
Bisoprolol
strontium ranelate
Metoprolol
Comorbidity
Propensity Score
Atrioventricular Block
Logistic Models
Insulin
Spatial Analysis
Information Storage and Retrieval
Italy
Odds Ratio
Databases
Guidelines
Confidence Intervals
Health

Cite this

Sessa, Maurizio ; Mascolo, Annamaria ; Rasmussen, Daniel Bech ; Kragholm, Kristian ; Jensen, Magnus Thorsten ; Sportiello, Liberata ; Rafaniello, Concetta ; Tari, Giuseppe Michele ; Pagliaro, Claudia ; Andersen, Morten ; Rossi, Francesco ; Capuano, Annalisa. / Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease : an Italian register-based cohort study. In: Scientific Reports. 2019 ; Vol. 9.
@article{b79ff54c059c42ddb87aaa6abd622c3d,
title = "Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease: an Italian register-based cohort study",
abstract = "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 na{\"i}ve 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.",
author = "Maurizio Sessa and Annamaria Mascolo and Rasmussen, {Daniel Bech} and Kristian Kragholm and Jensen, {Magnus Thorsten} and Liberata Sportiello and Concetta Rafaniello and Tari, {Giuseppe Michele} and Claudia Pagliaro and Morten Andersen and Francesco Rossi and Annalisa Capuano",
year = "2019",
month = "12",
day = "1",
doi = "10.1038/s41598-019-47967-y",
language = "English",
volume = "9",
journal = "Scientific Reports",
issn = "2045-2322",
publisher = "Nature Publishing Group",

}

Sessa, M, Mascolo, A, Rasmussen, DB, Kragholm, K, Jensen, MT, Sportiello, L, Rafaniello, C, Tari, GM, 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

Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease : an Italian register-based cohort study. / Sessa, Maurizio; Mascolo, Annamaria; Rasmussen, Daniel Bech; Kragholm, Kristian; Jensen, Magnus Thorsten; Sportiello, Liberata; Rafaniello, Concetta; Tari, Giuseppe Michele; Pagliaro, Claudia; Andersen, Morten; Rossi, Francesco; Capuano, Annalisa.

In: Scientific Reports, Vol. 9, 11465, 01.12.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease

T2 - an Italian register-based cohort study

AU - Sessa, Maurizio

AU - Mascolo, Annamaria

AU - Rasmussen, Daniel Bech

AU - Kragholm, Kristian

AU - Jensen, Magnus Thorsten

AU - Sportiello, Liberata

AU - Rafaniello, Concetta

AU - Tari, Giuseppe Michele

AU - Pagliaro, Claudia

AU - Andersen, Morten

AU - Rossi, Francesco

AU - Capuano, Annalisa

PY - 2019/12/1

Y1 - 2019/12/1

N2 - 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.

AB - 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.

U2 - 10.1038/s41598-019-47967-y

DO - 10.1038/s41598-019-47967-y

M3 - Journal article

VL - 9

JO - Scientific Reports

JF - Scientific Reports

SN - 2045-2322

M1 - 11465

ER -