P48 Should chronic obstructive pulmonary disease be a contra-indication to β blocker prescription in patients with concomitant heart failure?

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Beta blockers (BB) are now well established in the treatment of heart failure (HF) and other cardiovascular disorders. There is much debate in the literature as to their safety in patients with concomitant chronic obstructive pulmonary disease (COPD) due to the risk of increased symptoms and decline of FEV1. As BB use improves morbidity and mortality in CVD are we justified in denying this benefit to patients with co-existing COPD?


To ask cardiologists within our Deanery about their prescribing preferences for BB in patients with both HF and COPD and any adverse events they had experienced as a result of those prescriptions.


Four questions were sent out to 50 consultant cardiologists and 20 registrars asking BB of choice with adverse events experienced or reasons to avoid them.


30/50 Consultants responded with 7/20 registrar responses. 100% prescribed BB to patient with COPD and HF with only 6 (16%) responders describing adverse outcomes. These included increasing shortness of breath (6/37), wheeze (6/37) and bronchospasm (1/37). The most commonly prescribed BB was bisoprolol (89%), followed by nebivolol (40%), carvedilol (37%) and metoprolol (21%).


Our results show that a diagnosis of COPD is not considered a contraindication to BB prescription by cardiologists with few reporting an increase in symptoms. We would suggest that all patients with COPD and HF should at least be considered for BB therapy while being mindful of potential adverse effects.

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