Beta-blockers in Patients with Heart Failure with Reduced Ejection Fraction and Concomitant Chronic Obstructive Pulmonary Disease: Cardiovascular and Respiratory Outcomes

Beer, BN; Benson, L; Basile, C; Schrage, B; Becher, PM; Blankenberg, S; Kirchhof, P; Szabó-Söderberg, B; Metra, M; Lindberg, A; Imbalzano, E; Rosano, GMC; Karlström, P; Mol, PGM; Scorza, R; Lund, LH; Lindberg, F; Savarese, G

doi:10.1002/ejhf.70046

Heart failure & cardiomyopathies

Beta-blockers in Patients with Heart Failure with Reduced Ejection Fraction and Concomitant Chronic Obstructive Pulmonary Disease: Cardiovascular and Respiratory Outcomes

Eur J Heart FailPublished 11 Sep 2025Registry-based cohort study

Main finding · CV death/total HHFResultRelative risk 0.74 95% CI 0.58–0.96

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Authors' conclusion

In patients with HFrEF and COPD, beta-blocker use was associated with lower risk of cardiovascular death/total HHF, without evidence of safety concerns for COPD exacerbations.

Study context

Population: Patients with HFrEF and Chronic Obstructive Pulmonary Disease (COPD), Swedish Heart Failure (HF) Registry, 2006–202391.5% used beta-blockers
Participants: 5,084 patients

Exposure: Beta-blocker use vs no beta-blocker use
Outcome: CV death/total HF hospitalizations (effectiveness); total severe COPD exacerbations (respiratory safety)
Follow-up: 5-year

Methodological detailsoverlap-weighted, Falsification analyses suggested no influence from residual confounding.

Overlap-weighted
Falsification analyses suggested no influence from residual confounding.

Main finding

CV death/total HHF · median follow-up 2.5 years

Relative risk

0.74

95% CI 0.58–0.96

Beta-blocker usersvs No beta-blocker

RR 0.74 (95% CI 0.58–0.96)

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with beta-blocker users ←→ Higher risk with beta-blocker users →	RR (95% CI)
CV death/total HHF, crudeCrude	0.512	0.66 (0.56–0.78)
	0.512Relative risk (log scale)

CV death/total hospitalizations for HF (HHF) by LVEF <30% (subgroup)

Greater magnitude of association with lower risk in LVEF <30%; otherwise consistent across subgroups (including GOLD groups)

p for interaction = 0.004

Safety

Outcome	← Lower risk with beta-blocker users ←→ Higher risk with beta-blocker users →	RR (95% CI)
Total severe COPD exacerbationsBeta-blocker usersvs No beta-blockerAfter overlap weighting	0.512	0.99 (0.73–1.35)
Total severe COPD exacerbationsBeta-blocker usersvs No beta-blockerCrude	0.512	0.75 (0.60–0.93)
	0.512Relative risk (log scale)

Original publication

Beta-blockers in Patients with Heart Failure with Reduced Ejection Fraction and Concomitant Chronic Obstructive Pulmonary Disease: Cardiovascular and Respiratory Outcomes. Eur J Heart Fail. Published 11 September 2025. doi:10.1002/ejhf.70046

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