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. 2016 Aug;64(8):1574-82.
doi: 10.1111/jgs.14303. Epub 2016 Jul 22.

Treatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure

Kumar Dharmarajan  1   2 , Kelly M Strait  2 , Mary E Tinetti  3   4 , Tara Lagu  5   6   7 , Peter K Lindenauer  5   6   7 , Joanne Lynn  8 , Michelle R Krukas  9 , Frank R Ernst  9 , Shu-Xia Li  2 , Harlan M Krumholz  1   2   10   11
Affiliations

Treatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure

Kumar Dharmarajan et al. J Am Geriatr Soc. 2016 Aug.

Abstract

Objectives: To determine how often hospitalized older adults principally diagnosed with pneumonia, chronic obstructive pulmonary disease (COPD), or heart failure (HF) are concurrently treated for two or more of these acute cardiopulmonary conditions.

Design: Retrospective cohort study.

Setting: 368 U.S. hospitals in the Premier research database.

Participants: Individuals aged 65 and older principally hospitalized with pneumonia, COPD, or HF in 2009 or 2010.

Measurements: Proportion of diagnosed episodes of pneumonia, COPD, or HF concurrently treated for two or more of these acute cardiopulmonary conditions during the first 2 hospital days.

Results: Of 91,709 diagnosed pneumonia hospitalizations, 32% received treatment for two or more acute cardiopulmonary conditions (18% for HF, 18% for COPD, 4% for both). Of 41,052 diagnosed COPD hospitalizations, 19% received treatment for two or more acute cardiopulmonary conditions (all of which involved additional HF treatment). Of 118,061 diagnosed HF hospitalizations, 38% received treatment for two or more acute cardiopulmonary conditions (34% for pneumonia, 9% for COPD, 5% for both).

Conclusion: Hospitalized older adults diagnosed with pneumonia, COPD, or HF are frequently treated for two or more acute cardiopulmonary conditions, suggesting that clinical syndromes often fall between traditional diagnostic categories. Research is needed to evaluate the risks and benefits of real-world treatment for the many older adults whose presentations elicit diagnostic uncertainty or concern about coexisting acute conditions.

Keywords: cardiovascular disease; comorbidity; hospital medicine; pharmacoepidemiology; pulmonary diseases.

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Figures

Figure 1
Figure 1. Concurrent Treatments for Two or More Acute Cardiopulmonary Conditions Received by Pneumonia, Chronic Obstructive Pulmonary Disease, and Heart Failure Cohorts
Data is shown for pneumonia, chronic obstructive pulmonary disease (COPD), and heart failure cohorts in panels A, B, and C, respectively. Concurrent treatment for pneumonia cannot be determined during hospitalization for COPD, as antibiotic treatment is part of guideline-recommended therapy for COPD. Figure is drawn to scale. COPD: chronic obstructive pulmonary disease; IV: intravenous.
Figure 1
Figure 1. Concurrent Treatments for Two or More Acute Cardiopulmonary Conditions Received by Pneumonia, Chronic Obstructive Pulmonary Disease, and Heart Failure Cohorts
Data is shown for pneumonia, chronic obstructive pulmonary disease (COPD), and heart failure cohorts in panels A, B, and C, respectively. Concurrent treatment for pneumonia cannot be determined during hospitalization for COPD, as antibiotic treatment is part of guideline-recommended therapy for COPD. Figure is drawn to scale. COPD: chronic obstructive pulmonary disease; IV: intravenous.
Figure 1
Figure 1. Concurrent Treatments for Two or More Acute Cardiopulmonary Conditions Received by Pneumonia, Chronic Obstructive Pulmonary Disease, and Heart Failure Cohorts
Data is shown for pneumonia, chronic obstructive pulmonary disease (COPD), and heart failure cohorts in panels A, B, and C, respectively. Concurrent treatment for pneumonia cannot be determined during hospitalization for COPD, as antibiotic treatment is part of guideline-recommended therapy for COPD. Figure is drawn to scale. COPD: chronic obstructive pulmonary disease; IV: intravenous.
See this image and copyright information in PMC

References

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