Impact of Chronic Obstructive Pulmonary Disease on Long-Term Outcome of Patients Hospitalized for Heart Failure

Ruşinaru, Dan; Saaidi, Imen; Godard, Stephanie; Mahjoub, Haïfa; Battle, Caroline; Tribouilloy, Christophe

doi:10.1016/j.amjcard.2007.08.046

Cited by 88 publications

(70 citation statements)

References 22 publications

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“…Over time, comorbidity increased the fastest among the oldest beneficiaries compared to the youngest beneficiaries, with the greatest prevalence increases in those discordant conditions already more common among the oldest beneficiaries at the start of the study period. These findings support dual hypotheses regarding the relationship between comorbidity and advancing age among older adults with heart failure, namely, that even as the prevalence of comorbidity overall increases over time, the oldest-old continue to be more likely than the young-old to have more discordant conditions and less likely to have concordant comorbidities, particularly those shown to be associated with mortality [6][7][8]10 . Overall, the rate of accumulation of most discordant conditions (with the exception of cancer) exceeded the rate of accumulation of concordant comorbidities.…”

Section: Discussionsupporting

confidence: 67%

“…The characterization of chronic obstructive pulmonary disease was problematic. Although COPD is not pathophysiologically related to heart failure, the two conditions have highly overlapping signs and symptoms, and COPD has been shown to increase mortality risk in heart failure 7 . We therefore characterized COPD as concordant.…”

Section: Chronic Condition Measuresmentioning

confidence: 99%

“…This is of particular relevance to older adults with heart failure, as comorbidity in this population increases symptomatology 2 , polypharmacy 3 , risk of hospital readmissions 4,5 , and mortality [6][7][8][9][10] . Moreover, the management of comorbidity, particularly those conditions that are not directly related to heart failure in either pathogenesis or management, can significantly complicate the overall care needed by these patients 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Existing data support two potentially opposing hypotheses regarding the relationship between comorbidity and advancing age. On the one hand, evidence linking certain comorbidities in heart failure to increased mortality [6][7][8][9][10] suggests that persons who survive to very old age with heart failure are less likely to have those comorbidities. On the other hand, the increase in prevalence with advancing age of several chronic diseases unrelated to heart failure, such as dementia [13][14][15][16] , suggests that older adults with heart failure may accumulate comorbidity as they survive into old age.…”

Section: Introductionmentioning

confidence: 99%

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Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

et al. 2011

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BACKGROUND: Comorbidity-a condition that co-exists with a primary illness-is common among older persons with heart failure and can complicate the overall management of this population. OBJECTIVES: To determine the relationship between advancing age and the prevalence and patterns of comorbidity among older persons with heart failure. DESIGN: Retrospective longitudinal cohort study PARTICIPANTS: A total of 201,130 Medicare beneficiaries with heart failure stratified into three age strata in 2001: 66-75, 76-85, and 86+ years, and followed over 5 years. MEASUREMENTS: (1) Prevalence of 19 conditions as identified by the Chronic Conditions Warehouse fromMedicare claims data, characterized as concordant (related to heart failure) or discordant (unrelated to heart failure), and (2) overall comorbidity burden, defined as count of conditions. RESULTS: The median number of comorbidities rose from four (IQR: 2-5) to five (IQR: 4-7) among the youngold, and from 4 (IQR: 3-6) to 6 (IQR: 5-8) among the middle-old and oldest-old between 2001 and 2006. In 2001, the majority of concordant conditions were more prevalent among the youngest than oldest beneficiaries (e.g., diabetes 46.2% vs 26.9%; kidney disease 21.8% vs 18.4%), while the majority of discordant conditions were more prevalent among the oldest-old than youngest-old beneficiaries (e.g., dementia 39.6% vs 9.9%; hip fracture 9.5% vs 1.9%). Discordant conditions increased in prevalence faster among the oldest than youngest beneficiaries (e.g., dementia 13% points versus 9% points). CONCLUSION: Among older Medicare beneficiaries with heart failure, there is a higher overall burden of comorbidity and greater prevalence of discordant comorbidity among the oldest old. Comorbidity prevalence increases over time, with discordant comorbidity increasing at the fastest rate among the oldest old. This comorbidity burden highlights the challenge of effectively treating heart failure while simultaneously managing co-existing and unrelated conditions.

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Section: Discussionsupporting

confidence: 67%

Section: Chronic Condition Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

et al. 2011

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“…COPD is a predictor of mortality in heart failure [42], indeed, 5-year survival in heart failure patients with COPD is 31% compared with 71% in its absence [43]. Diastolic dysfunction on echocardiography in patients admitted for COPD exacerbations exhibit a longer length of stay and perhaps a higher exacerbation frequency [44].…”

Section: Heart Failure Secondary To Ischemic Heart Disease And/or Hypermentioning

confidence: 99%

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

Patel

Hurst

2011

Expert Review of Respiratory Medicine

138

108

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The effect of three major co‐morbidities on quality of life and outcome of patients with heart failure with reduced ejection fraction

et al. 2021

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Aims Diabetes mellitus, chronic obstructive pulmonary disease, and chronic kidney disease are prevalent in patients with heart failure with reduced ejection fraction (HFrEF). We have analysed the impact of co-morbidities on quality of life (QoL) and outcome. Methods and results A total of 397 patients (58.8 ± 11.0 years, 73.6% with New York Heart Association functional class ≥3) with stable advanced HFrEF were followed for a median of 1106 (inter-quartile range 379-2606) days, and 68% of patients (270 patients) experienced an adverse outcome (death, urgent heart transplantation, and implantation of mechanical circulatory support). Chronic obstructive pulmonary disease was present in 16.4%, diabetes mellitus in 44.3%, and chronic kidney disease in 34.5% of patients; 33.5% of patients had none, 40.0% had one, 21.9% had two, and 3.8% of patient had three co-morbidities. Patients with more co-morbidities reported similar QoL (assessed by Minnesota Living with Heart Failure Questionnaire, 45.46 ± 22.21/49.07 ± 21.69/47.52 ± 23.54/46.77 ± 23.60 in patients with zero to three co-morbidities, P for trend = 0.51). Multivariable regression analysis revealed that furosemide daily dose, systolic blood pressure, New York Heart Association functional class, and body mass index, but not the number of co-morbidities, were significantly (P < 0.05) associated with QoL. Increasing co-morbidity burden was associated with worse survival (P < 0.0001), lower degree of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker treatment (P = 0.001), and increasing levels of BNP (mean of 685, 912, 1053, and 985 ng/L for patients with zero to three co-morbidities, P for trend = 0.008) and cardiac troponin (sm-cTnI, P for trend = 0.0496), which remained significant (P < 0.05) after the adjustment for left ventricular ejection fraction, left ventricular end-diastolic diameter, right ventricular dysfunction grade, body mass index, and estimated glomerular filtration rate. Conclusions In stable advanced HFrEF patients, co-morbidities are not associated with impaired QoL, but negatively affect the prognosis both directly and indirectly through lower level of HF pharmacotherapy and increased myocardial stress and injury.

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Impact of Chronic Obstructive Pulmonary Disease on Long-Term Outcome of Patients Hospitalized for Heart Failure

Cited by 88 publications

References 22 publications

Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

The effect of three major co‐morbidities on quality of life and outcome of patients with heart failure with reduced ejection fraction

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