Prognostic influence of prior chronic obstructive pulmonary disease in patients admitted for their first episode of acute heart failure

Abstract

Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in heart failure (HF) patients. Whether a prior COPD diagnosis influences patients' prognosis in early stages of HF is unknown. We reviewed patients > 50 years old admitted because of a first episode of acute HF. We divided the sample into two groups according to the existence of a prior diagnosis of COPD. We used regression analysis to identify the baseline patients' characteristics associated with the presence of COPD, and Cox mortality analysis to identify baseline and discharge data related to higher risk of a combined outcome of 1-year all-cause readmission or mortality. Finally, 985 patients were included in the analysis; 212 (21.5%) with a prior diagnosis of COPD. Baseline characteristics were similar between both groups except for a much higher prevalence of male gender, higher number of chronic therapies, and lower prevalence of atrial fibrillation among COPD patients. The combined primary outcome is significantly more prevalent in COPD patients (68.4 vs. 59.8%, p = 0.022). Cox analysis identified this prior diagnosis of COPD (HR 1.282, 95% CI 1.063-1.547; p = 0.001) as an independent risk factor for 1-year readmission and mortality, together with older age, higher admission creatinine and potassium values, and a higher number of chronic therapies. Our study confirms that in a "real-life" cohort of elderly patients experiencing a first episode of acute HF, the presence of a prior diagnosis of COPD is common, and confers a higher risk of adverse outcomes (death or readmission) during the year following discharge.

Predictors of Referral to Cardiac Rehabilitation in Patients following Hospitalisation with Heart Failure: A Multivariate Regression Analysis

“…It is well established that older individuals are disproportionately affected by HF [ 26 ]. Older patients with HF are characterised by a higher incidence of comorbidities such as COPD, anaemia, sarcopenia, and frailty [ 26 , 27 , 28 , 29 , 30 ], and they experience higher rates of hospitalisation and clinically adverse events in comparison to younger individuals with HF [ 27 , 31 ]. These factors present a challenging paradox, as patients with more complex presentations or patients who are older may have the greatest need for CR.…”

New-Onset Atrial Fibrillation Is a Risk Factor of Ischemic Stroke in Chronic Obstructive Pulmonary Disease

“…However, past studies with congestive heart failure combined with COPD have found that the presence of COPD significantly reduces the prescription of beta blockers at discharge. Educating physicians about selective beta blockers for COPD can reduce AF and thus reduce IS [ 34 ]. The ARISTOTLE study found a higher mortality rate for AF and COPD, and the use of anticoagulants effectively reduced the incidence of stroke or systemic embolism with COPD compared with non-COPD [ 35 ].…”

Three-month mortality in permanently bedridden medical non-oncologic patients. The BECLAP study (permanently BEdridden, creatinine CLearance, albumin, previous hospital admissions study)

“…Thirdly, many scores predict mortality at medium-long term, i.e. at 12 months, a time window that is less relevant for clinical decisionmaking [19,28,[30][31][32][33][34][35][36][37][38][39][40][41][42]. Other studies addressed 6-months mortality [8,43], and often for specific diseases such as heart failure, dementia, cirrhosis [15].…”