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

作者：Jennifer Kathleen Quint, Emily L. Herrett, Krishnan Bhaskaran, A. Timmis, Harry Hemingway, Jadwiga Anna Wedzicha, Liam L Smeeth · 发表于：BMJ · 年份：2013 · DOI：10.1136/bmj.f6650 · 被引用次数：126 · 研究领域：Chronic Obstructive Pulmonary Disease (COPD) Research、Acute Myocardial Infarction Research、Heart Failure Treatment and Management

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 m...