Under-Utilisation Of Beta-Blockers In Patients With Acute Coronary Syndrome And Comorbid Chronic Obstructive Pulmonary Disease

Background: beta-blockers are an established mainstay of therapy in acute coronary syndrome (ACS). Despite substantial evidence of their safety and efficacy in chronic obstructive pulmonary disease (COPD) patients, their use in this population remains limited internationally, likely due to fears of inducing bronchospasm. In Australia, little is known about the use of beta-blockers in COPD patients hospitalised for ACS.Aim: To determine if beta-blockers are under-prescribed at discharge for patients with COPD hospitalised for ACS compared to patients without a diagnosis of COPD.Methods: Retrospective analysis of a tertiary metropolitan hospital computer database was undertaken to identify the first 250 patients hospitalised with ACS from 1 March 2015.Results: Of the 250 patients analysed, there were five in-hospital fatalities, leaving 245 patients for final analysis. Patients with ACS and COPD received fewer beta-blockers at discharge than those with ACS alone (66.7% vs 86.2%, P < 0.05). After controlling for clinically meaningful confounding factors, a logistic regression analysis model determined that, for patients with ACS, the presence of COPD was the only significant predictor of receiving a beta-blocker at discharge.Conclusion: Despite strong evidence supporting the use of beta-blockers in COPD patients with ACS, Australian patients with COPD remain under-treated for ACS. More work is needed to alter prescribing attitudes.