HF GDMT was associated with a 38% lower in-hospital mortality odds (aOR 0.62) and a 17% lower post-discharge mortality risk (aHR 0.83) in patients hospitalized for ECOPD.
Does guideline-directed medical therapy (GDMT) for heart failure and COPD reduce in-hospital and post-discharge mortality in heart failure patients hospitalized for COPD exacerbation?
In patients with heart failure hospitalized for a COPD exacerbation, the use of guideline-directed medical therapy for both conditions is associated with significantly lower in-hospital and post-discharge mortality.
Absolute Event Rate: 0% vs 0%
Rationale: Real-world effectiveness of cardiovascular and LABA/LAMA treatment in patients with heart failure (HF) during hospitalized exacerbation of COPD (ECOPD) is limited.Objectives: To investigate associations of guideline-directed medical therapy (GDMT) during hospitalization with in-hospital and post-discharge all-cause mortality and readmission risk.Methods: HF patients aged 18 years hospitalized for ECOPD were included in this Belgian nationwide observational cohort between 2017-2022.HF GDMT was defined as use of at least beta-blockers in combination with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors following 2016 ESC guidelines, whereas COPD GDMT was defined as use of at least LABA+LAMA following 2017 GOLD report.Multivariable adjusted logistic regression and time-to-event analyses were used to investigate the associations.Main results: Among 14,582 patients (mean age 76.8 years, 40.7% females), GDMT was dispensed for HF only (20.4%), COPD only (23.6%) or both HF and COPD (11.9%).During hospitalization, 14.1% (2,058/14,582) died: 18.1% (no GDMT), 11.1% (HF GDMT), 11.0% (COPD GDMT) and 7.9% (both GDMT), respectively.HF GDMT was significantly associated with a 38% lower in-hospital mortality odds (aOR 0.62, 95%CI 0.55-0.70),while COPD GDMT was independently associated with a 40% lower odds (aOR 0.60, 95%CI 0.53-0.67).HF GDMT, alone (aHR 0.83, 95%CI 0.77-0.88)or combined with COPD GDMT (aHR 0.82, 95%CI 0.75-0.89),was associated with a significantly lower post-discharge mortality risk, whereas no significant associations between GDMT and readmission were observed.Conclusions: These results highlight the importance of HF GDMT, alongside optimised COPD management during hospitalization, to reduce in-hospital and post-discharge mortality risk.
Vauterin et al. (Sun,) reported a other. HF GDMT was associated with a 38% lower in-hospital mortality odds (aOR 0.62) and a 17% lower post-discharge mortality risk (aHR 0.83) in patients hospitalized for ECOPD.