Prevalence, healthcare burden, and longitudinal outcomes of chronic obstructive pulmonary disease among people with heart failure

Background Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common comorbidities. We aimed to assess healthcare resource utilization and outcomes associated with COPD in patients hospitalized for HF. Methods This was an exploratory cohort analysis of patients hospitalized for HF and enrolled in the Patient-Centered Care Transitions in HF cluster-randomized trial. The primary outcome was all-cause mortality. Secondary outcomes included all cause and HF hospitalization, healthcare resource utilization, and direct healthcare costs. Survival was evaluated using Cox-proportional hazards models adjusted for baseline variables. Results Among 4441 patients discharged alive, 1136 (25.6%) had COPD at baseline. All-cause mortality was higher at 5 years among patients with COPD (75.2% vs. 60.9%, adjusted HR 1.29, 95% CI 1.19, 1.40). Patients with COPD had more frequent all-cause rehospitalizations (mean [Standard Deviation (SD)] 3.4 [6.6] vs. 2.7 [8.6] per patient, p = 0.01), but no significant difference in HF rehospitalizations (mean [SD] 0.9 [2.3] vs. 0.9 [4.5] per patient, p = 0.74). Patients with COPD had greater annual physician visits, multidisciplinary clinic visits, and supportive care (all p < 0.01); and greater annual direct healthcare costs in Canadian dollars (at 5 years $91,888 [109,319] vs. $76,823 [116,218]) than those without COPD, primarily driven by rehospitalizations. Conclusions Among patients discharged alive after hospitalization for HF, COPD is common and is associated with higher all-cause mortality and all-cause rehospitalizations, greater healthcare utilization, and higher direct healthcare costs. Interventions to reduce the healthcare burden in HF should include broad approaches that address important comorbidities.