title: Impact of COPD on the mortality and treatment of patients hospitalized with acute decompensated heart failure: the Worcester Heart Failure Study.
abstract: 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.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Fisher
authors.affiliation: Department of Medicine, Baystate Medical Center, Springfield, MA.
authors.forename: Mihaela S
authors.initials: MS
authors.lastname: Stefan
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Chad
authors.initials: C
authors.lastname: Darling
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Electronic address: Robert.Goldberg@umassmed.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D010045:Outpatients; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors