Metoprolol in Patients With HFrEF and COPD

Inclusion criteria

• A definite diagnosis of HFrEF (LVEF≤40%), NYHA II to IV , and the disease is due to ischemic heart disease or dilated cardiomyopathy;
• A definite diagnosis of COPD with moderate or higher airflow limitation (FEV1/FVC < 0.7 and FEV1 < 80% of the expected value);
• Age ≥18 years old;
• Informed consent has been obtained and signed.

Exclusion criteria

• the dose of Metoprolol before enrollment was more than 23.75mg/d;
• Resting heart rate < 50 beats/min;
• Second or third degree atrioventricular block;
• Atrial fibrillation;
• Sick sinus syndrome;
• Systolic blood pressure < 90mmHg;
• Acute attack of bronchial asthma;
• Liver insufficiency (serum transaminase > 3 times the normal value);
• Renal insufficiency (eGFR < 30ml/min/1.73m2, or serum creatinine > 2.5mg/dL[> 221μmol/L]);
• Patients with serious physical diseases, such as cancer;
• Patients who have a history of allergy to the investigational drug or its ingredients;
• Participating in other clinical investigators;
• During the study period, Patients cannot live in the selected center for a long time, which is not conducive to the follow-up;
• Patients with disability, mobility disability, intellectual disability and other factors that may prevent normal participation in the study and follow-up, and their frailty was assessed by the FRAIL frailty screening scale; Intellectual mental status was assessed by the Mini-Mental State Examination (MMSE).
• Poor adherence or other reasons considered by the researchers to be unsuitable for the clinical trial.