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
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.
DOI of Published Version
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.