Beta-blockers in critically ill patients with chronic obstructive airway disease and cardiovascular disease: an analysis of three critical care medicine databases

Objective This study aimed to evaluate the association between beta-blocker use and all-cause in-hospital mortality in critically ill patients with coexisting chronic obstructive airway disease (COAD) and cardiovascular disease (CVD), particularly during the acute exacerbation phase—a context not previously studied. Methods We conducted a retrospective cohort study using data from three publicly available intensive care databases (MIMIC-IV, eICU-CRD, and NWICU). Adult patients with both COAD and CVD who were admitted to the ICU within 48 hours of hospitalization were included. Patients were categorized into beta-blocker and non-beta-blocker groups. Doubly robust estimation methods, including inverse probability of treatment weighting (IPTW) and propensity score matching (PSM), were used to control for confounders. The primary outcome was all-cause in-hospital mortality, with secondary outcomes of ICU and hospital length of stay. Results Among 2,753 included patients, 1,314 received beta-blockers. After adjustment for confounders, beta-blocker use was associated with a significant reduction in all-cause in-hospital mortality (odds ratio [OR] = 0.55; 95% confidence interval [CI] = 0.35–0.86; P = 0.008). Subgroup analysis indicated that the mortality benefit was observed primarily in patients hospitalized for CVD (OR = 0.37; 95% CI = 0.21–0.64; P < 0.001), but not in those hospitalized for COAD. No significant differences were found in ICU or hospital length of stay between the two groups. Conclusion Beta-blockers are not contraindicated in critically ill patients with COAD and CVD and may reduce mortality in those hospitalized primarily for cardiovascular indications. Cardioselective beta-blockers should be administered when clinically indicated, even during acute exacerbations.