|Title:||Evidence of potential bias in a comparison of β blockers and calcium channel blockers in patients with chronic obstructive pulmonary disease and acute coronary syndrome: Results of a multinational study||Authors:||Dong Y.-H.
|Issue Date:||2017||Publisher:||BMJ Publishing Group||Journal Volume:||7||Journal Issue:||3||Start page/Pages:||e012997||Source:||BMJ Open||Abstract:||
Objectives A number of observational studies have reported that, in patients with chronic obstructive pulmonary disease (COPD), β blockers (BBs) decrease risk of mortality and COPD exacerbations. To address important methodological concerns of these studies, we compared the effectiveness and safety of cardioselective BBs versus non-dihydropyridine calcium channel blockers (non-DHP CCBs) in patients with COPD and acute coronary syndromes (ACS) using a propensity score (PS)-matched, active comparator, new user design. We also assessed for potential unmeasured confounding by examining a short-term COPD hospitalisation outcome. Setting and participants We identified 22985 patients with COPD and ACS starting cardioselective BBs or non-DHP CCBs across 5 claims databases from the USA, Italy and Taiwan. Primary and secondary outcome measures Stratified Cox regression models were used to estimate HRs for mortality, cardiovascular (CV) hospitalisations and COPD hospitalisations in each database after variable-ratio PS matching. Results were combined with random-effects meta-analyses. Results Cardioselective BBs were not associated with reduced risk of mortality (HR, 0.90; 95% CI 0.78 to 1.02) or CV hospitalisations (HR, 1.06; 95% CI 0.91 to 1.23), although statistical heterogeneity was observed across databases. In contrast, a consistent, inverse association for COPD hospitalisations was identified across databases (HR, 0.54; 95% CI 0.47 to 0.61), which persisted even within the first 30days of follow-up (HR, 0.55; 95% CI 0.37 to 0.82). Results were similar across a variety of sensitivity analyses, including PS trimming, high dimensional-PS matching and restricting to high-risk patients. Conclusions This multinational study found a large inverse association between cardioselective BBs and short-term COPD hospitalisations. The persistence of this bias despite state-of-the-art pharmacoepidemiologic methods calls into question the ability of claims data to address confounding in studies of BBs in patients with COPD. ? Published by the BMJ Publishing Group Limited.
|ISSN:||2044-6055||DOI:||10.1136/bmjopen-2016-012997||SDG/Keyword:||angiotensin receptor antagonist; antiarrhythmic agent; anticoagulant agent; antidiabetic agent; antihypertensive agent; antithrombocytic agent; beta adrenergic receptor blocking agent; bronchodilating agent; calcium channel blocking agent; corticosteroid; digoxin; dipeptidyl carboxypeptidase inhibitor; diuretic agent; fibric acid derivative; hydroxymethylglutaryl coenzyme A reductase inhibitor; nitric acid derivative; renin inhibitor; beta adrenergic receptor blocking agent; calcium channel blocking agent; acute coronary syndrome; aged; Article; chronic obstructive lung disease; data base; female; follow up; hospitalization; human; major clinical study; male; mortality; mortality risk; propensity score; proportional hazards model; sensitivity analysis; acute coronary syndrome; chronic obstructive lung disease; comorbidity; comparative study; disease exacerbation; factual database; Italy; middle aged; pathophysiology; statistical bias; Taiwan; United States; very elderly; Acute Coronary Syndrome; Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Bias; Calcium Channel Blockers; Comorbidity; Databases, Factual; Disease Progression; Female; Hospitalization; Humans; Italy; Male; Middle Aged; Mortality; Propensity Score; Proportional Hazards Models; Pulmonary Disease, Chronic Obstructive; Taiwan; United States
|Appears in Collections:||醫學系|
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