Scompenso cardiaco e BPCO: c’è spazio per i beta-bloccanti? Dott. Enrico Strocchi

1. Scompenso cardiaco e BPCO: c’è spazio per i beta-bloccanti? Dott. Enrico Strocchi

2. Prevalence and incidence of COPD in Pts. with Heart Failure 61 practices with 377439 patients provided data to the Primary Care Clinical Informatics Unit at the University of Aberdeen (Hawkins et Al, Eur J Heart Failure 2010)

3. 650 GPs 909638 Pts. 39741 with Asthma 25281 with COPD

4. COPD = 628 Pts Non-COPD = 4382 Pts (Staszewsky et Al, J Cardiac Failure 2007)

5. (Staszewsky et Al, J Cardiac Failure 2007)

6. 4133 Pts, hospitalized with worsening HF and EF≤40% 416 with COPD (Mentz et Al, J Cardiac Failure 2012)

7. HR = 1,42 (of dying) HR = 1,26 (of non-fatal events) (Macchia et Al, Eur J Heart Failure 2006)

8. (Pocock et Al, on behalf of MAGGIC, Eur Heart J 2012)

9. 405 Pts. >65 yrs Follow-up = 4,2 yrs (Boudestein et Al, Eur J Heart Failure 2009)

10. A few preliminary thoughts… • Epidemiological studies and everyday clinical practice shows that COPD and CV diseases are very often combined; • The prognosis of CV diseases is worse when COPD is also present; • Intensive drug treatment of cardiac disease is therefore necessary; • Which are the possible effects of β-blockers in patients with COPD?

11. Pharmacological characteristics of -blockers (da Matera et Al, Pulmonary Pharmacology & Therapeutics 2010)

12. -receptors’ distribution

13. Impact of different classes of -blockers on airways in patients with COPD = mild decrease; =moderate decrease; =severe decrease; 0= no effect (da Matera et Al, Pulmonary Pharmacology & Therapeutics 2010)

14. Properties of -blockers approved for the treatment of HF (from Hawkins et Al, JACC 2011)

15. Differences among 1-selective -blockers (Terbutaline 6 μg/Kg/h) (Nuttall et al J Clin Pharm Ther 2003)

16. (Chang et Al, Int Med J 2010)

17. (FEV1 of subjects who commenced the study on Carvedilol) (Jabbour et Al, JACC 2010)

19. (from Hawkins et Al, JACC 2011)

20. (Staszewsky et Al, J Cardiac Failure 2007)

21. (Hatkins et Al JACC 2011)

22. Merit-HF The only trial without COPD or useofbronchodilatorsamong the exclusioncriteria 210 (5,3%) of the 3.991 patientsincludedhad a documenteddiagnosisof COPD. The incidenceofpulmonaryadverseeventswassimilar in metoprolol or placebo-treatedgroups: bronchospasm 0,3 vs 0,4%; COPD exacerbations (0,4 vs 0,4%); respiratorytractinfections (2,0% vs 1,9%).

23. Trends in -blocker prescribing in patients with Heart Failure (Hawkins et Al, Eur J Heart Failure 2010)

24. Prevalence of β-blockers use in HF patients in Bologna (S.Orsola-Malpighi Hospital) 336 Pts. with HF discharged from hospital in 2011 Standardized dose

25. 2230 Pts. With COPD Age 64,8 yrs Follow-up 7,2 yrs 686 deaths (Arch Intern Med 2010)

26. (Arch Intern Med 2010)

27. TARDIS Tayside (Scotland) 5977 Pts. Follow-up = 4,35 yrs (Short et Al, 2011)

28. Adjusted hazard ratios for all cause mortality among patients with COPD divided according to type of treatment (Short et Al, BMJ 2011)

30. 2249 Pts. On long-term oxygen therapy Median follow-up 1,1 yrs (Ekstrӧm et al, Am J Crit Respir Care Med 2013)

31. To sum up: • Patients with COPD are to be considered at higher cardiovascular risk because of the consequences of pulmonary disease; • Therefore they deserve the “best preventive treatment” to reduce their CV risk • Treatment with β-blockers of patients with heart failure and mild to moderate COPD is possible and it reduces mortality and morbidity and it could possibly reduce also COPD exacerbations but … RCT’s are needed.