Abstract

Background: The use of beta-blockers in patients with heart failure with reduced ejection fraction (HFrEF) and  coexisting COPD remains controversial. This study evaluated their feasibility, prognosis, and dose-dependent effects.

Methods: This retrospective study included 805 patients with HFrEF co-existed with COPD. 279 received beta-blockers and 526 did not. Beta-blocker users were stratified into < 25% and ≥ 25% of the recommended dose. Two- and five-year outcomes were assessed using Kaplan-Meier and Cox regression analyses.

Results: Patients on < 25% beta-blocker dose had significantly lower two- and five-year all-cause mortality than non-users (both p < 0.05). This benefit persisted after adjusting for age, ejection fraction, and bronchodilator use (HR 0.67; 95% CI 0.48–0.94; p = 0.021).

Conclusions: This study suggests that beta-blockers may be safely used in HFrEF patients with COPD, starting at low doses. Further studies should assess their effect on HF-related readmissions.