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Chest. 2015 Mar;147(3):637-645. doi: 10.1378/chest.14-0607.

Impact of COPD on the mortality and treatment of patients hospitalized with acute decompensated heart failure: the Worcester Heart Failure Study.

Author information

1
Department of Medicine, University of Massachusetts Medical School, Worcester.
2
Department of Medicine, Baystate Medical Center, Springfield, MA.
3
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester.
4
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
5
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Electronic address: Robert.Goldberg@umassmed.edu.

Abstract

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 β-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.

PMID:
25188234
PMCID:
PMC4347532
DOI:
10.1378/chest.14-0607
[Indexed for MEDLINE]
Free PMC Article

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