Outcomes in patients hospitalized for heart failure and chronic obstructive pulmonary disease: differences in clinical profile and treatment between 2002 and 2009.
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently co-exist, and each is a major public health issue. In a large cohort of hospitalized HF patients, we evaluated: (i) the impact of COPD on clinical outcomes; (ii) whether outcomes and treatments changed from 2002 to 2009; and (iii) the relationship between outcomes and treatments focusing on beta-blockers (BBs) and bronchodilators (BDs).



From linkable Lombardy administrative health databases, we selected individuals with a discharge diagnosis of HF with or without concomitant COPD (HF yesCOPD and HF noCOPD) in 2002 and 2009. Patients were followed up for 4 years. Outcomes were total mortality, first readmission for HF, and their combination. Unadjusted and adjusted Cox proportional models and competing risk analyses were used. We identified 11 274 patients with HF noCOPD and 2837 with HF yesCOPD. HF yesCOPD patients in 2002 and 2009 had a 20% higher risk of the outcomes. From 2002 to 2009, BB and BD prescriptions increased significantly. In HF noCOPD patients, risks for mortality [adjusted hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.86-0.97], first HF readmission (HR 0.79, 95% CI 0.74-0.85), and the combined endpoint (HR 0.88, 95% CI 0.84-0.92) declined (all P < 0.003) while in HF yesCOPD only the risk for first HF readmission dropped (HR 0.86, 95% CI 0.76-0.97; P = 0.018). BBs were associated with significantly lower mortality in both groups, but with a higher risk for first HF readmission in HF noCOPD. Outcomes did not significantly differ in HF yesCOPD treated or not with BDs.



The prognosis of patients hospitalized for HF, either with or without COPD, seemed to improve between 2002 and 2009, with possibly better survival of those on BBs. Because of residual confounding in observational studies, a randomized controlled trial should be considered to confirm these results.
Laboratory of Cardiovascular Clinical Pharmacology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
Lidia
L
Staszewsky
Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
Laura
L
Cortesi
Laboratory of Geriatric Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
Mauro
M
Tettamanti
Unit of Internal and Respiratory Medicine, Fatebenefratelli e Oftalmico Hospital, Milan, Italy.
Gabrio Andrea
GA
Dal Bo
Regional Health Ministry, Lombardy Region, Milan, Italy.
Ida
I
Fortino
Regional Health Ministry, Lombardy Region, Milan, Italy.
Angela
A
Bortolotti
Regional Health Ministry, Lombardy Region, Milan, Italy.
Luca
L
Merlino
Laboratory of Cardiovascular Clinical Pharmacology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
Roberto
R
Latini
Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
Maria Carla
MC
Roncaglioni
Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
Marta
M
Baviera
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy; D018680:Cholinergic Antagonists; D015331:Cohort Studies; D004071:Digitalis Glycosides; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D000960:Hypolipidemic Agents; D016247:Information Storage and Retrieval; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D009026:Mortality; D015999:Multivariate Analysis; D009566:Nitrates; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014970:Xanthines / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D001993:Bronchodilator Agents; D002121:Calcium Channel Blockers; D018680:Cholinergic Antagonists; D004071:Digitalis Glycosides; D004232:Diuretics; D000960:Hypolipidemic Agents; D000451:Mineralocorticoid Receptor Antagonists; D009566:Nitrates; D010975:Platelet Aggregation Inhibitors; D014970:Xanthines
Chronic obstructive pulmonary disease; Epidemiology; Heart failure; Outcome; Treatment