CardioExchange Archive

Beta-Blockers May Benefit COPD Patients: Although many physicians prefer not to prescribe beta-blockers to patients with COPD, a new observational study from the Netherlands suggests that COPD patients — even those who don’t have overt cardiovascular disease — may benefit from beta-blocker therapy. In their paper in Archives of Internal Medicine, Rutten and colleagues analyzed records of 2,230 COPD patients and found that beta-blocker usage was associated with reduced mortality and fewer exacerbations of COPD.

In an accompanying editorial, Don Sin and SF Paul Man agree with Rutten et al. that a large, randomized trial is needed before the findings can be fully accepted, but add that the data “provide a rationale for the practicing clinicians to use β-blockers … cautiously in their patients with COPD who also have a coexisting cardiovascular condition for which a β-blocker is required.” The new data, they write, “has turned the story of β-blockers in COPD into a curious case of a foe becoming a potential friend to millions of patients with COPD worldwide.”

Evaluation of ALLHAT ‘Academic Detailing’: In response to concerted efforts to blunt the impact of the controversial Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the NHLBI initiated a dissemination project that utilized “academic detailing” to communicate the results to practicing physicians. Now, in a report in Archives of Internal Medicine from the ALLHAT Collaborative Research Group, the impact of that project is evaluated. Stafford et al. report an increase in use of diuretics in areas where academic detailing was most active, in contrast to small decreases or a smaller increase in areas where little or no detailing occurred.

In an accompanying commentary, Jerry Avorn, who in 1983 invented the concept and coined the term “academic detailing,” praises the intentions of the effort but points out a number of reasons for the modest observed effect, including the absence of the “interactive, one-on-one presentation of a message to a practicing clinician by an experienced change agent,” which is the hallmark of successful pharmaceutical company marketing. Avorn writes that budget limitations may have limited the ability of the project to perform real academic detailing.