Differences in clinical characteristics, management and short-term outcome between acute heart failure patients chronic obstructive pulmonary disease and those without this co-morbidity.
ALARM-HF was a retrospective, observational registry that included 4,953 patients admitted for acute heart failure (AHF) in six European countries, Turkey, Mexico and Australia. Data about respiratory disorders and related medications were available for 4,616 patients with AHF.


RESULTS
Chronic obstructive pulmonary disease (COPD) patients (n = 1,143, 24.8%) were older and more frequently men (p < 0.001) when compared to non-COPD patients. Despite the equivalent left ventricular ejection fraction (38.6 ± 13.7 vs. 38.2 ± 14.5%, p > 0.05), COPD patients more frequently presented with acutely decompensated heart failure (p < 0.001). Moreover, a worse cardiovascular profile was observed in the COPD group, including more atrial fibrillation/flutter, diabetes, hypertension, obesity, peripheral vascular disease (p < 0.001). Before admission, a higher percentage of COPD patients had experienced infections (25.0 vs. 14.0 %, p < 0.001), and were more likely to receive diuretics (p = 0.006), ACE inhibitors (p = 0.042), nitrates (p = 0.003), and digoxin (p = 0.034). With the exception of ACE inhibitors, those differences maintained at discharge, with concomitant increase in ARBs prescription (p = 0.01). Notably, β-blockers were less prescribed before admission (21.1 vs. 23.8%, p = 0.055) in COPD patients, and remained underutilized at discharge (p < 0.001). Correcting for baseline differences, all-cause in-hospital mortality did not differ between COPD and non-COPD groups (10.1 vs. 10.9%, p = 0.085).


CONCLUSIONS
A large proportion of AHF patients presented with concomitant COPD, had different clinical characteristics/co-morbidities, and less frequently received evidence-based pharmacological therapy compared to non-COPD patients. However, the in-hospital mortality was not higher in COPD group.
Second Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece, jparissis@yahoo.com.
John T
JT
Parissis
Chiara
C
Andreoli
Nikolaos
N
Kadoglou
Ignatios
I
Ikonomidis
Dimitrios
D
Farmakis
Ioanna
I
Dimopoulou
Efstathios
E
Iliodromitis
Maria
M
Anastasiou-Nana
Mitja
M
Lainscak
Giussepe
G
Ambrosio
Alexandre
A
Mebazaa
Gerasimos
G
Filippatos
Ferenc
F
Follath
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors