Impact of COPD on the mortality and treatment of patients hospitalized with acute decompensated heart failure: the Worcester Heart Failure Study
Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine; Department of Emergency Medicine; Department of Quantitative Health Sciences
Medical Subject Headings
Acute Disease; Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Comorbidity; Female; Heart Failure; *Hospital Mortality; Humans; *Inpatients; Male; Massachusetts; Outpatients; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Survival Rate; Treatment Outcome
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Respiratory Tract Diseases
BACKGROUND: COPD is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and postdischarge mortality and treatment of patients hospitalized with ADHF according to COPD status.
METHODS: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during four study years: 1995, 2000, 2002, and 2004. Patients were followed through 2010 for determination of their vital status.
RESULTS: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable, adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 year (adjusted relative risk [RR], 1.10; 95% CI, 1.06-1.14) and 5 years (adjusted RR, 1.40; 95% CI, 1.28-1.52) after hospital discharge than patients who were not previously diagnosed with COPD.
CONCLUSIONS: COPD is a common comorbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and ensure that patients with ADHF and COPD receive optimal treatment modalities.
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Citation: Chest. 2015 Mar;147(3):637-45. doi: 10.1378/chest.14-0607. Link to article on publisher's site
Fisher, Kimberly A.; Stefan, Mihaela S.; Darling, Chad E.; Lessard, Darleen M.; and Goldberg, Robert J., "Impact of COPD on the mortality and treatment of patients hospitalized with acute decompensated heart failure: the Worcester Heart Failure Study" (2015). University of Massachusetts Medical School Faculty Publications. 664.