Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis
Objective To evaluate the association between having concomitant chronic obstructive pulmonary disease (COPD) or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute heart failure (HF).Setting Data were obtained from patients enrolled in the National H...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e059122.full |
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| author | Claudia Gulea Rosita Zakeri Jennifer K Quint Constantinos Kallis |
| author_facet | Claudia Gulea Rosita Zakeri Jennifer K Quint Constantinos Kallis |
| author_sort | Claudia Gulea |
| collection | DOAJ |
| description | Objective To evaluate the association between having concomitant chronic obstructive pulmonary disease (COPD) or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute heart failure (HF).Setting Data were obtained from patients enrolled in the National Heart Failure Audit.Participants 217 329 patients hospitalised for HF in England–Wales between March 2012 and 2018.Outcomes In-hospital mortality, referrals to cardiology follow-up and prescriptions for HF medications were compared between patients with comorbid COPD (COPD-HF) or asthma (asthma-HF) versus HF-alone using mixed-effects logistic regression.Results Patients with COPD-HF were more likely to die during hospitalisation, and those with asthma-HF had a reduced likelihood of death, compared with patients who had HF-alone ((adjusted)ORadj, 95% CI: 1.10, 1.06 to 1.14 and ORadj, 95% CI: 0.84, 0.79 to 0.88). In patients who survived to discharge, referral to HF follow-up services differed between groups: patients with COPD-HF had reduced odds of cardiology follow-up (ORadj, 95% CI 0.79, 0.77 to 0.81), while cardiology referral odds for asthma-HF were similar to HF-alone. Overall, proportions of HF medication prescriptions at discharge were low for both COPD-HF and asthma-HF groups, particularly prescriptions for beta-blockers.Conclusions In this nationwide analysis, we showed that COPD and asthma significantly impact the clinical course in patients hospitalised for HF. COPD is associated with higher in-patient mortality and lower cardiology referral odds, while COPD and asthma are both associated with lower use of prognostic HF therapies on discharge. These data highlight therapeutic gaps and a need for better integration of cardiopulmonary services to improve healthcare provision for patients with HF and coexisting respiratory disease. |
| format | Article |
| id | doaj-art-922caafac0664c0fa03dd6aad432a028 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-922caafac0664c0fa03dd6aad432a0282025-01-24T05:05:10ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-059122Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysisClaudia Gulea0Rosita Zakeri1Jennifer K Quint2Constantinos Kallis3NIHR Imperial Biomedical Research Centre, London, UKBritish Heart Foundation Centre for Research Excellence, King’s College London, London, UK3 School of Public Health, Imperial College London, London, UKDepartment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UKObjective To evaluate the association between having concomitant chronic obstructive pulmonary disease (COPD) or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute heart failure (HF).Setting Data were obtained from patients enrolled in the National Heart Failure Audit.Participants 217 329 patients hospitalised for HF in England–Wales between March 2012 and 2018.Outcomes In-hospital mortality, referrals to cardiology follow-up and prescriptions for HF medications were compared between patients with comorbid COPD (COPD-HF) or asthma (asthma-HF) versus HF-alone using mixed-effects logistic regression.Results Patients with COPD-HF were more likely to die during hospitalisation, and those with asthma-HF had a reduced likelihood of death, compared with patients who had HF-alone ((adjusted)ORadj, 95% CI: 1.10, 1.06 to 1.14 and ORadj, 95% CI: 0.84, 0.79 to 0.88). In patients who survived to discharge, referral to HF follow-up services differed between groups: patients with COPD-HF had reduced odds of cardiology follow-up (ORadj, 95% CI 0.79, 0.77 to 0.81), while cardiology referral odds for asthma-HF were similar to HF-alone. Overall, proportions of HF medication prescriptions at discharge were low for both COPD-HF and asthma-HF groups, particularly prescriptions for beta-blockers.Conclusions In this nationwide analysis, we showed that COPD and asthma significantly impact the clinical course in patients hospitalised for HF. COPD is associated with higher in-patient mortality and lower cardiology referral odds, while COPD and asthma are both associated with lower use of prognostic HF therapies on discharge. These data highlight therapeutic gaps and a need for better integration of cardiopulmonary services to improve healthcare provision for patients with HF and coexisting respiratory disease.https://bmjopen.bmj.com/content/12/6/e059122.full |
| spellingShingle | Claudia Gulea Rosita Zakeri Jennifer K Quint Constantinos Kallis Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis BMJ Open |
| title | Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis |
| title_full | Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis |
| title_fullStr | Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis |
| title_full_unstemmed | Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis |
| title_short | Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis |
| title_sort | impact of copd and asthma on in hospital mortality and management of patients with heart failure in england and wales an observational analysis |
| url | https://bmjopen.bmj.com/content/12/6/e059122.full |
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