COPD Increases Hospitalization, Death in Heart Failure Patients

Claire Lawson, PhD

Heart failure and chronic obstructive pulmonary disease (COPD) are among the leading causes of hospital admissions and mortality in older individuals around the world, according to Claire Lawson, PhD, of her own titular Diabetes Research Centre, University of Leicester, Leicester General Hospital, in the United Kingdom.

“When patients suffer both, their risk of admission and death increases even higher. This which is burdensome for patients and health services and very expensive to manage,” Lawson said in an interview with MD Magazine®.

A recent study led by Lawson sought to determine whether the highest risk patients with heart failure and COPD could be identified utilizing readily available data, found that among patients with heart failure.

The study, a United Kingdom-based, nested case-control study with risk-set sampling, utilized the Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics between 2002 and 2014. Participants included 50,114 patients aged 40 years and older with a new diagnosis of HF in their family practice clinical record ­—the largest population-based study of heart failure, according to Lawson—and who had at least three years of CPRD-approved clinical data prior to their study entry.

Patients were followed up until their date of transfer out of practice, their index outcome event, or 2014.

“Our findings show that 1 in 7 patients with heart failure in the community also has COPD, which carries a 30% increase in risk of death and hospitalization compared with patients with HF but without COPD,” investigators wrote.

Lawson and her team found that COPD increased the risk of hospital admission and death by more than one-third, according to the study. However, the study found that increased risk was specific to patients receiving the most intense course of COPD medication, including triple inhaler therapy, prescribed oral corticosteroids, or oxygen therapy, according to the study.

“Those prescribed short-acting inhaled β-mimetics or the most intensive medication regimes were at a much higher risk of admission and death,” Lawson said. “Patients with more severe airflow limitation were at much higher risk of death and admission as were women.

These severity markers, she noted, can be used to target patients with HF and COPD in order to optimize treatments for both conditions, to prevent admissions and death.

The number of patients with heart failure who were coded with COPD was significantly lower than the researchers anticipated.

“This means that there are likely to be HF patient’s with COPD that are not known and not treated,” Lawson said.

Additionally, half of the patients coded with COPD had a spirometry reading. The lack of spirometry recording, coupled with the large overlap between heart failure and COPD symptoms, signs, and chest radiography, electrocardiography, and spirometry results, indicates that a significant number of patients may be misdiagnosed with COPD, Lawson said.

“These patients might be wrongly prescribed short-acting inhaled β-mimetics, which we found increases risk, and not prescribed important HF medications used to improve outcomes,” Lawson said.

Ultimately, the team found that optimal care of patients with heart failure and COPD requires accurate diagnosis and assessment.

“Spirometry should be performed more regularly and when HF patients are euvolemic,” Lawson said. “Specialist tests such as body plethysmography should be made available for community patients to aid diagnosis."

The study, "Association of Medication Intensity and Stages of Airflow Limitation With the Risk of Hospitalization or Death in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease," was published online in JAMA.