Impact of heart failure and other comorbidities on mortality in patients with chronic obstructive pulmonary disease: a register-based, prospective cohort study

Abstract

BackgroundMultimorbidity has already become common in primary care and will be a challenge in the future. Primary care in Sweden participates to a great extent in the care of patients with two severe, chronic conditions: chronic obstructive pulmonary disease (COPD) and heart failure. Both conditions are characterized by high mortality and often coexist. Age, sex, heart failure and other comorbidities are considered to be the major predictors of mortality in patients with COPD. We aimed to study the impact of heart failure, other comorbidities, age and sex on mortality in patients with COPD.MethodsA register-based, prospective cohort study conducted in Blekinge County in Sweden with about 150,000 inhabitants. The study population was comprised of people aged ≥35 years. The data about diagnoses of COPD and heart failure came from the 2007 health care register, in which we found 984 individuals with a diagnosis of COPD. Date of death was collected from January 1st, 2008 –August 31st, 2015. The diagnosis-based Adjusted Clinical Groups (ACG) Case-Mix System 7.1 was used to describe comorbidity. Each individual was assigned one of six comorbidity levels called resource utilization bands (RUB) graded from 0 to 5.ResultsEstimated eight year mortality in patients with COPD and coexisting heart failure was seven times higher than in patients with COPD alone - odds ratio 7.06 (95% CI 3.88–12.84). Adjusting for age and male sex resulted in odds ratio 3.75 (95% CI 1.97–7.15). Further adjusting for other comorbidities resulted in odds ratio 3.26 (95% CI 1.70–6.25).The mortality was strongly associated with the highest comorbidity level – RUB 5 where the odds ratio was 5.19 (95% CI 2.59–10.38).ConclusionHeart failure has an important impact on mortality in patients with COPD. The mortality in patients with COPD and coexisting heart failure was strongly associated with age, male sex and other comorbidities. Of those three predictors, only other comorbidities can be influenced. Heart failure and other comorbidities should be recognized early and properly treated in order to improve survival in patients with coexisting COPD and heart failure.

<p>Early Predictors of Mortality in Patients with COPD, in Relation to Respiratory and Non-Respiratory Causes of Death – A National Register Study</p>

“…Demographic variables from the SRTR comprise age and gender. Patient-related variables concern airway obstruction, measured by FEV 1% after bronchodilation if available, otherwise without bronchodilation, as well as oxygen saturation, number of exacerbations, and number of hospital admissions due to COPD in the last 12 months, BMI, which was categorized as <22, [22][23][24][25][26][27][28][29][30], and >30 kg/m 2 , and comorbidity. Patient-reported variables comprised smoking, exercise activity, measured by reported number of days with physical activity per week, and functional dyspnea, measured using the modified Medical Research Council (mMRC) Dyspnea Scale.…”

<p>Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk</p>

“…8,9 These multimorbidities were associated with higher health care costs, ED visits, mortality, and readmissions. [10][11][12] Readmission serves as one important indicator measuring the quality and utilization of expensive inpatient care that adds to total health care costs. In 2012, due to a trend of increasing inpatient total charges for 30-day COPDrelated readmissions, 13 the Centers for Medicare and Medicaid services (CMS) initiated the Hospital Readmissions Reduction Program (HRRP).…”

“…Prior research reported that male and female patients were different in terms of COPDrelated 30-day readmission. 7,11,19 Males were more likely to be readmitted, 19,20 whereas females had fewer comorbidities and might be undertreated for COPD, itself. 21 Although gender plays an important role in COPD readmission, few studies have navigated how gender might affect the COPD-related 30-day readmission rate among patients with and without additional comorbidities.…”

Lymphatic Pump Manipulation in Patients with Chronic Obstructive Pulmonary Disease

“…The cost-sternal and cost-vertebral joints are more rigid and calcified in patients with COPD than people without the disease [4,45]. Due to their respiratory condition, these patients have difficulty remaining on their backs for 20-30 minutes at a time and are often associated with heart failure and dyspnea [46]. As described earlier in this article, the rib cage is rigid, in an inspiratory attitude and shows postural changes [2].…”