Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia

Abstract

There is controversy regarding the impact of chronic obstructive pulmonary disease (COPD) in clinical outcomes in elderly patients with pneumonia. Comorbidities such as cardiovascular disease have been reported to play an important role in patients with acute exacerbations of COPD. However, limited data are available regarding the impact of cardiovascular disease in elderly COPD patients who require hospitalisation for pneumonia. We examined a cohort of subjects with pneumonia and pre-existing COPD. Prior cardiovascular disease was defined as history of myocardial infarction, congestive heart failure, cardiac arrhythmia, unstable angina or stroke. Outcomes examined included 30-day, 90-day, 6-month and 1-year mortality. We included 17 140 elderly COPD patients who were hospitalised for pneumonia. Prior cardiovascular disease was present in 10 240 (59.7%) patients. Prior cardiovascular disease was independently associated with 90-day mortality (21.3% versus 19.4%; hazard ratio (HR) 1.29, 95% CI 1.02–1.17), 6-month mortality (29.0% versus 26.1%; HR 1.28, 95% CI 1.07–1.50) and 12-month mortality (39.2% versus 34.5%; HR 1.33, 95% CI 1.15–1.54) when compared to no prior cardiovascular disease. The temporal differential effect between groups increases from 1.0% at 30 days to 4.7% at 1 year. Prior cardiovascular disease is associated with increased long-term mortality in elderly COPD patients with pneumonia. Differences in mortality rates increased over time.

Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans

“…25,27 Comorbidities considered prevalent at baseline were defined using the same approach. We included those that have been associated with pneumonia in uninfected populations, namely congestive heart failure (CHF) 22,23,28 and other cardiovascular diseases, 29 chronic renal and liver disease, 30,31 diabetes mellitus, 23,32 malignancy 30 and as well as hepatitis C infection (HCV). Prior pneumonia diagnoses were also defined by ICD-9 codes.…”

“…The same variables were included in all three multivariable models and were selected a priori given potential pathogenic mechanisms or epidemiologic data linking them with risk for different types of pulmonary infections. 22,23,29–31,33 We did not include prior pneumonia in these models because we were unable to determine the temporal relationship between prior pneumonia events and development of COPD.…”

Chronic comorbidity of internal organs as a risk factor of complications and fatal outcome of community-acquired pneumonia.

“…Найчастіше це були серцева недостат-ність (65,1%), аритмії (60,9%), інфаркт міокарда (29,5%) та нестабільна стенокардія (29,2%). У цих пацієнтів частіше спостерігались цукровий діабет та цереброваскулярні захворювання [8].…”

The relationship of chronic obstructive pulmonary disease and coronary heart disease: problems of pathogenesis and treatment strategy

“…ХОЗЛ під час загострення може проявлятись і позалеге-невими захворюваннями (такими як ІМ), призводячи до госпітальної смерті [19], особливо осіб літнього віку (≥ 65 років) [20]. У деяких дослідженнях встановлено, що за-гострення ХОЗЛ є головною причиною СС смертності не тільки під час і відразу після гострих подій, але і в довго-строковій перспективі.…”