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Original Research: COPD |

Impact of COPD on the Mortality and Treatment of Patients Hospitalized With Acute Decompensated Heart FailureCOPD and Acute Heart Failure: The Worcester Heart Failure Study

Kimberly A. Fisher, MD; Mihaela S. Stefan, MD; Chad Darling, MD; Darleen Lessard, MS; Robert J. Goldberg, PhD
Author and Funding Information

From the Department of Medicine (Dr Fisher), Department of Emergency Medicine (Dr Darling), and Department of Quantitative Health Sciences (Ms Lessard and Dr Goldberg), University of Massachusetts Medical School, Worcester; and the Department of Medicine (Dr Stefan), Baystate Medical Center, Springfield, MA.

CORRESPONDENCE TO: Robert J. Goldberg, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA 01605; e-mail: Robert.Goldberg@umassmed.edu


FOR EDITORIAL COMMENT SEE PAGE 586

FUNDING/SUPPORT: Funding for this study was provided by the National Heart, Lung, and Blood Institute [Grant R37 HL69874].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):637-645. doi:10.1378/chest.14-0607
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BACKGROUND:  COPD is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and postdischarge mortality and treatment of patients hospitalized with ADHF according to COPD status.

METHODS:  The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during four study years: 1995, 2000, 2002, and 2004. Patients were followed through 2010 for determination of their vital status.

RESULTS:  Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including β-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable, adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 year (adjusted relative risk [RR], 1.10; 95% CI, 1.06-1.14) and 5 years (adjusted RR, 1.40; 95% CI, 1.28-1.52) after hospital discharge than patients who were not previously diagnosed with COPD.

CONCLUSIONS:  COPD is a common comorbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and ensure that patients with ADHF and COPD receive optimal treatment modalities.

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