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Outcomes in patients hospitalized for heart failure and chronic obstructive pulmonary disease: differences in clinical profile and treatment between 2002 and 2009
Author(s) -
Staszewsky Lidia,
Cortesi Laura,
Tettamanti Mauro,
Dal Bo Gabrio Andrea,
Fortino Ida,
Bortolotti Angela,
Merlino Luca,
Latini Roberto,
Roncaglioni Maria Carla,
Baviera Marta
Publication year - 2016
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.519
Subject(s) - medicine , heart failure , pulmonary disease , cardiology , intensive care medicine , disease
Aims Heart failure ( HF ) and chronic obstructive pulmonary disease ( COPD ) frequently co‐exist, and each is a major public health issue. In a large cohort of hospitalized HF patients, we evaluated: (i) the impact of COPD on clinical outcomes; (ii) whether outcomes and treatments changed from 2002 to 2009; and (iii) the relationship between outcomes and treatments focusing on beta‐blockers ( BBs ) and bronchodilators ( BDs ). Methods and results From linkable Lombardy administrative health databases, we selected individuals with a discharge diagnosis of HF with or without concomitant COPD ( HF yesCOPD and HF noCOPD ) in 2002 and 2009. Patients were followed up for 4 years. Outcomes were total mortality, first readmission for HF , and their combination. Unadjusted and adjusted Cox proportional models and competing risk analyses were used. We identified 11 274 patients with HF noCOPD and 2837 with HF yesCOPD . HF yesCOPD patients in 2002 and 2009 had a 20% higher risk of the outcomes. From 2002 to 2009, BB and BD prescriptions increased significantly. In HF noCOPD patients, risks for mortality [adjusted hazard ratio ( HR ) 0.91, 95% confidence interval ( CI ) 0.86–0.97], first HF readmission ( HR 0.79, 95% CI 0.74–0.85), and the combined endpoint ( HR 0.88, 95% CI 0.84–0.92) declined (all P < 0.003) while in HF yesCOPD only the risk for first HF readmission dropped ( HR 0.86, 95% CI 0.76–0.97; P = 0.018). BBs were associated with significantly lower mortality in both groups, but with a higher risk for first HF readmission in HF noCOPD . Outcomes did not significantly differ in HF yesCOPD treated or not with BDs . Conclusions The prognosis of patients hospitalized for HF , either with or without COPD , seemed to improve between 2002 and 2009, with possibly better survival of those on BBs . Because of residual confounding in observational studies, a randomized controlled trial should be considered to confirm these results.