Concomitant COPD in primary heart failure increased long-term mortality (HR 1.22; 95% CI 1.09-1.36), and concomitant HF in primary COPD increased long-term mortality (HR 1.48; 95% CI 1.25-1.76).
Observational (n=5,131)
No
Does the coexistence of heart failure and COPD impact in-hospital and long-term mortality in patients hospitalized for acute dyspnea?
The coexistence of heart failure and COPD in patients presenting with acute dyspnea significantly increases long-term mortality, with heart failure having a particularly strong prognostic impact in patients with primary COPD.
Effect estimate: OR 0.74 (95% CI 0.55-0.99)
Absolute Event Rate: 8.5% vs 11.7%
p-value: p=0.050
Abstract Background Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are leading causes of acute dyspnea in the emergency department (ED) and frequently coexist. However, their combined impact on short- and long-term outcomes in the acute setting remains insufficiently characterized. Methods We conducted a monocentric observational study based on the PARADISE cohort, including patients admitted to the ED for acute dyspnea between 2010 and 2019. Patients with a primary diagnosis of HF or COPD were included and stratified according to the presence of the alternate condition. The primary outcomes were in-hospital and post-discharge all-cause mortality, assessed using multivariable regression models. Results Among 5,131 patients, 3,543 had a primary diagnosis of HF and 1,588 of COPD. Concomitant disease was present in approximately 20% of patients in both groups. In the primary HF cohort, patients with COPD had lower in-hospital mortality compared with those without COPD (8.5% vs. 11.7%, p = 0.014), but similar overall mortality (69.3% vs. 68.9%). After adjustment, COPD remained associated with lower in-hospital mortality (OR 0.74; 95% CI 0.55–0.99; p = 0.050) and with a modest increase in long-term mortality (HR 1.22; 95% CI 1.09–1.36; p 0.001). In the primary COPD cohort, patients with HF had higher in-hospital mortality (7.4% vs. 3.4%, p = 0.001) and markedly higher long-term mortality (68.7% vs. 48.7%, p 0.001). After adjustment, HF was not significantly associated with in-hospital mortality (OR 1.54; 95% CI 0.87–2.65; p = 0.13), but remained strongly associated with increased long-term mortality (HR 1.48; 95% CI 1.25–1.76; p 0.001). Conclusions HF and COPD frequently coexist and are both associated with an increased long-term mortality risk, with a greater prognostic impact of HF in patients with COPD. These findings highlight the importance of systematic identification and optimized management of both conditions in this high-risk population.
Baudry et al. (Thu,) conducted a observational in Acute dyspnea with primary Heart Failure or COPD (n=5,131). Concomitant COPD vs. Absence of COPD was evaluated on In-hospital mortality in primary heart failure cohort (OR 0.74, 95% CI 0.55-0.99, p=0.050). Concomitant COPD in primary heart failure increased long-term mortality (HR 1.22; 95% CI 1.09-1.36), and concomitant HF in primary COPD increased long-term mortality (HR 1.48; 95% CI 1.25-1.76).