Could patients with chronic obstructive pulmonary disease benefit from renin angiotensin system inhibitors? A meta-analysis

The Impact of Beta-Blockers and Renin-Angiotensin-Aldosterone System Inhibitors on the Prognosis of Atrial Fibrillation Patients with Chronic Obstructive Pulmonary Disease: A Nation-Wide Registry Study

Purpose

The management of the coexistence of chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) remains unclear due to a lack of evidence. This study aimed to find the effect of beta-blockers and renin-angiotensin-aldosterone system inhibitors (RAASi) in this special population.

Patients and Methods

We designed an observational real-world study that included 2016 AF patients from 20 hospitals across the country. The diagnosis of COPD was extracted from case report forms and confirmed by specialists. The study endpoint was all-cause mortality. Kaplan-Meier curves and Log rank test were used to analyse the prognosis of different treatments. Several multivariable Cox regression models were performed to identify the independent prognostic value of the medications.

Results

Approximately 30% of patients were prescribed beta-blockers or RAASi. Survival curves showed that beta-blockers did not affect all-cause mortality in AF patients with COPD (P=0.130). Patients with RAASi had a better prognosis than those without (P=0.011). After multivariable Cox regression analysis adjusting for demographics, other comorbidities and treatments, beta-blockers and angiotensin II receptor blockers (ARB) did not independently affect the endpoint. Angiotensin converting enzyme inhibitors (ACEI) remained a protective factor for overall survival in AF patients with COPD (model 1: HR=0.45, 95% CI 0.21-0.98, P=0.045; model 2: HR=0.41, 95% CI 0.18-0.93, P=0.034; model 3: HR=0.38, 95% CI 0.16-0.89, P=0.026).

Conclusion

Beta-blockers did not affect overall survival in patients with AF and COPD, whereas ACEI may be protective.

A 7-point evidence-based care discharge protocol for patients hospitalized for exacerbation of COPD: consensus strategy and expert recommendation

Acute exacerbations of COPD (ECOPD) are an important event in the life of a COPD patient as it causes significant deterioration of physical, mental, and social health, hastens disease progression, increases the risk of dying and causes a huge economic loss. Preventing ECOPD is therefore one of the most important goals in the management of COPD. Before the patient is discharged after hospitalization for ECOPD, it is crucial to offer an evidence-based care bundle protocol that will help minimize the future risk of readmissions and death. To develop the content of this quality care bundle, an Expert Working Group was formed, which performed a systematic review of literature, brainstormed, and debated on key clinical issues before arriving at a consensus strategy that could help physicians achieve this goal. A 7-point consensus strategy was prepared, which included: (1) enhancing awareness and seriousness of ECOPD, (2) identifying patients at risk for future exacerbations, (3) optimizing pharmacologic treatment of COPD, (4) identifying and treating comorbidities, (5) preventing bacterial and viral infections, (6) pulmonary rehabilitation, and (7) palliative care. Physicians may find this 7-point care bundle useful to minimize the risk of future exacerbations and reduce morbidity and mortality.

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

PURPOSE OF REVIEW

Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are both significant burdens on the healthcare system and often coexist. Mechanistic links between the two conditions and their clinical impact are increasingly understood.

RECENT FINDINGS

Recent studies demonstrate multiple mechanisms by which the pathobiology of COPD may have negative effects on the cardiovascular system. These include extrapulmonary consequences of the COPD inflammatory state, cardiac autonomic dysfunction, which has been recently implicated in worsening respiratory symptoms and exacerbation risk, and mechanical effects of lung hyperinflation on left ventricular diastolic function.Clinical studies have consistently shown a high prevalence of CVD in COPD patients and worsened outcomes (and vice versa ). Exacerbations of COPD have also been demonstrated to dramatically increase the risk of cardiovascular events. While some safety concerns exist, medications for COPD and cardiovascular disease should be used in accordance with respective guidelines. However, real-world data show suboptimal management for patients with COPD and CVD.

SUMMARY

COPD and cardiovascular disease have complicated interrelationships. Further mechanistic studies may lead to defining better targets for interventions. Education for medical professionals and implementation of novel screening protocols should be encouraged to fill in the gaps in clinical care for these patients.