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. 2023 Mar;18(2):523-534.
doi: 10.1007/s11739-023-03207-w. Epub 2023 Feb 11.

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Ernesto Crisafulli  1   2 , Giulia Sartori  3   4 , Alice Vianello  4 , Fabiana Busti  4 , Alessandro Nobili  5 , Pier Mannuccio Mannucci  6 , Domenico Girelli  4 ; REPOSI Investigators
Collaborators, Affiliations

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Ernesto Crisafulli et al. Intern Emerg Med. 2023 Mar.

Abstract

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF.

Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death.

Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009).

Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population.

Keywords: Chronic obstructive pulmonary disease; Heart failure; Hospital cure; Mortality; Multimorbidity; Prognosis.

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Conflict of interest statement

The authors declare they have no financial interests.

Figures

Fig. 1
Fig. 1
Percentage of deaths during hospitalization and in the follow-up of 3 and 6 months and one year. *p < 0.05 versus COPD. Numbers over black bars represent the absolute number of deaths
Fig. 2
Fig. 2
Kaplan–Meier curves. The analysis has been performed with the Gehan–Breslow–Wilcoxon test. CV indicates cardiovascular
See this image and copyright information in PMC

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