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Effect of β blockers on mortality after myocardial infarction in adults with COPD: Population based cohort study of UK electronic healthcare records

Title: Effect of β blockers on mortality after myocardial infarction in adults with COPD: Population based cohort study of UK electronic healthcare records
Authors: Quint, JK
Herrett, E
Bhaskaran, K
Timmis, A
Hemingway, H
Wedzicha, JA
Smeeth, L
Item Type: Journal Article
Abstract: Objectives: To investigate whether the use and timing of prescription of β blockers in patients with chronic obstructive pulmonary disease (COPD) having a first myocardial infarction was associated with survival and to identify factors related to their use. Design: Population based cohort study in England. Setting: UK national registry of myocardial infarction (Myocardial Ischaemia National Audit Project (MINAP)) linked to the General Practice Research Database (GPRD), 2003-11. Participants: Patients with COPD with a first myocardial infarction in 1 January 2003 to 31 December 2008 as recorded in MINAP, who had no previous evidence of myocardial infarction in their GPRD or MINAP record. Data were provided by the Cardiovascular Disease Research using Linked Bespoke studies and Electronic Health Records (CALIBER) group at University College London. Main outcome measure: Cox proportional hazards ratio for mortality after myocardial infarction in patients with COPD in those prescribed β blockers or not, corrected for covariates including age, sex, smoking status, drugs, comorbidities, type of myocardial infarction, and severity of infarct. Results: Among 1063 patients with COPD, treatment with β blockers started during the hospital admission for myocardial infarction was associated with substantial survival benefits (fully adjusted hazard ratio 0.50, 95% confidence interval 0.36 to 0.69; P<0.001; median follow-up time 2.9 years). Patients already taking a β blocker before their myocardial infarction also had a survival benefit (0.59, 0.44 to 0.79; P<0.001). Similar results were obtained with propensity scores as an alternative method to adjust for differences between those prescribed and not prescribed β blockers. With follow-up started from date of discharge from hospital, the effect size was slightly attenuated but there was a similar protective effect of treatment with β blockers started during hospital admission for myocardial infarction (0.64, 0.44 to 0.94; P=0.02). Conclusions: The use of β blockers started either at the time of hospital admission for myocardial infarction or before a myocardial infarction is associated with improved survival after myocardial infarction in patients with COPD. Registration: NCT01335672.
Issue Date: 22-Nov-2013
Date of Acceptance: 25-Oct-2013
URI: http://hdl.handle.net/10044/1/23972
DOI: https://dx.doi.org/10.1136/bmj.f6650
ISSN: 1468-5833
Publisher: BMJ Publishing Group Ltd
Journal / Book Title: British Medical Journal
Volume: 347
Copyright Statement: © 2013, British Medical Journal Publishing Group. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
Publication Status: Published
Article Number: f6650
Appears in Collections:Population Genetics and Gene Therapy
National Heart and Lung Institute
Faculty of Medicine



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