Beta-blocker, aspirin and statin usage after first-time myocardial infarction in patients with chronic obstructive pulmonary disease: a nationwide analysis from 1995 to 2015 in Denmark

Aims: To determine whether beta-blockers, aspirin, and statins are underutilized after first-time myocardial infarction (MI)in patients with chronic obstructive pulmonary disease (COPD) compared with patients without COPD. Further, todetermine temporal trends, and risk factors for non-use.

Methods and Results: Using Danish nationwide registers, we performed a cross-sectional study investigating the utilization of betablockers, aspirin and statins after hospitalisation for first-time MI among patients with and without COPD from 1995to 2015. Risk factors for non-use were examined in multivariable logistic regression models. During 21 years of study, 140,278 patients were included, hereof 13,496 (9.6%) with COPD. Patients with COPD were less likely to use beta-blockers (53.2% vs. 76.2%, P < 0.001), aspirin (73.9% vs. 78.8%, P < 0.001), and statins (53.5% vs. 61.9%, P < 0.001). Medication usage increased during the study period but inmultivariable analyses, COPD remained a significant predictor for non-use: OR [95% CI] for non-use of betablockers 1.86 [1.76-1.97]; aspirin 1.24 [1.16-1.32]; statins 1.50 [1.41-1.59]. Analyses stratified by ST-segmentelevation myocardial infarction (STEMI) and non-STEMI showed similar undertreatment of COPD patients. Risk factors for non-use of beta-blockers in COPD included increasing age, female sex, andincreasing severity of COPD (frequent exacerbations, use of multiple inhaled medications, low lung function). Similar findings were demonstrated for aspirin and statins.

Conclusion: Beta-blockers, and to a lesser extent aspirin and statins, were systematically underutilized by patients with COPD following hospitalisation for MI despite an overall increase in the utilization over time. Increasing severity of COPDwas a risk factor for non-use of the medications.