title: Heart failure and levels of other comorbidities in patients with chronic obstructive pulmonary disease in a Swedish population: a register-based study.
abstract: BACKGROUND
  Despite the fact that heart failure and chronic obstructive pulmonary disease (COPD) often exist together and have serious clinical and economic implications, they have mostly been studied separately. Our aim was to study prevalence of coexisting heart failure and COPD in a Swedish population. A further goal was to describe levels of other comorbidity and investigate where the patients received care: primary, secondary care or both.
  
  
  METHODS
  We conducted a register-based, cross-sectional study. The population included all people older than 19 years, living in Östergötland County in Sweden. The data were obtained from the Care Data Warehouse register from the year 2006. The diagnosis-based Adjusted Clinical Groups Case-Mix System 7.1 was used to describe the comorbidity level.
  
  
  RESULTS
  The prevalence of the diagnosis of heart failure in patients with COPD was 18.8% while it was 1.6% in patients without COPD. Age standardized prevalence was 9.9 and 1.5%, respectively. Standardized relative risk for the diagnosis of heart failure in patients with COPD was 6.6. The levels of other comorbidity were significantly higher in patients with coexisting heart failure and COPD compared to patients with either heart failure or COPD alone. Primary care was the only care provider for 36.2% of patients with the diagnosis of heart failure and 20.7% of patients with coexisting diagnoses of heart failure and COPD. Primary care participated furthermore in shared care of 21.5% of patients with the diagnosis of heart failure and 21.7% of patients with coexisting diagnoses of heart failure and COPD. The share of care between primary and secondary care varied depending on levels of comorbidity both in patients with coexisting heart failure and COPD and patients with heart failure alone.
  
  
  CONCLUSIONS
  Patients with coexisting diagnoses of heart failure and COPD are common in the Swedish population. Patients with coexisting heart failure and COPD have higher levels of other comorbidity than patients with heart failure or COPD alone. Primary care in Sweden participates to a great extent in care of patients with diagnoses of heart failure alone and coexisting heart failure and COPD.
authors.affiliation: Olofström Primary Health Care Centre, 293 32, Olofström, Sweden. elzbieta.kaszuba@med.lu.se.|Department of Clinical Sciences in Malmö, General Practice/Family Medicine, Lund University, 205 02, Malmö, Sweden. elzbieta.kaszuba@med.lu.se.
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Kaszuba
authors.affiliation: Department of Clinical Sciences in Malmö, General Practice/Family Medicine, Lund University, 205 02, Malmö, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Odeberg
authors.affiliation: Department of Clinical Sciences in Malmö, General Practice/Family Medicine, Lund University, 205 02, Malmö, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Råstam
authors.affiliation: Department of Clinical Sciences in Malmö, General Practice/Family Medicine, Lund University, 205 02, Malmö, Sweden.|Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, 5000, Odense, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Halling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012042:Registries / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Chronic obstructive pulmonary disease; Comorbidity; Delivery of health care; Diagnosis; Heart failure; Primary care; Registries