Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival.
Eur J Intern Med
; 60: 31-38, 2019 02.
Article
em En
| MEDLINE
| ID: mdl-30446355
ABSTRACT
BACKGROUND:
Chronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of ß-blockers at discharge and mortality in patients with COPD.METHODS:
We studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality.RESULTS:
After adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06-1.47; pâ¯=â¯.007). The relative risk of death for COPD patients increased steeply from 30 to 180â¯days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of ß-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53-0.83; pâ¯≤.001).CONCLUSIONS:
Our data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of ß-blockers at discharge is independently associated with improved survival in ADHF patients with COPD.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Antagonistas Adrenérgicos beta
/
Doença Pulmonar Obstrutiva Crônica
/
Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article