ORIGINAL RESEARCH ARTICLE The safety of beta-blocker s in

Full list of author information is available at the end of the articleBackground The majority of patients with chronic obstructive pul-monary disease (COPD) have chronic heart failure (CHF) or coronary artery disease (CAD) [1]. The risk of cardiac arrhythmia is increased during acute exacer-bations of COPD [1]. Atrial fibrillation (AF) is fre-quently observed in elderly COPD patients [2], and cardiac arrhythmias are a significant cause of mortality in these patients [3]. COPD patients with CAD generally have elevated heart rates, and beta-adrenergic receptor an-tagonists (beta-blockers) are known to improve the sur-vival of patients with CHF or CAD [4,5]. Previous studies have shown that patients with CAD and coexisting COPD generally failed to receive optimal therapy or appropriate drug dosages for HR reduction. In a recent study, 54 % of patients suffered from heart failure in a population with CAD and COPD, and only 52.8 % of these patients were receiving beta-blocker therapy. In addition, in the majorit