Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK.
Eur J Heart Fail. 2010 Jan;12(1):17-24. doi: 10.1093/eurjhf/hfp160. Epub 2009 Nov 30.
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist and present major challenges to healthcare providers. The epidemiology, consultation rate, and treatment of patients with HF and COPD in primary care are ill-defined.
This was an analysis of cross-sectional data from 61 primary care practices (377 439 patients) participating in the Scottish Continuous Morbidity Recording scheme. The prevalence of COPD in patients with HF increased from 19.8% in 1999 to 23.8% in 2004. In 2004, the prevalence was similar in men and women (24.8% vs. 22.9%, P = 0.09), increased with age up to 75 years, and increased with greater socioeconomic deprivation (most deprived 31.3% vs. least deprived 18.6%, P = 0.01). Contact rates for HF or COPD in those with both conditions were greater than disease-specific contact rates in patients with either condition alone. Although overall beta-blocker prescribing increased over time; the adjusted odds of beta-blocker prescription in patients with COPD was low and failed to improve [odds ratio 0.30 (0.28-0.32), P < 0.001]. In 2004, only 18% of individuals with HF and COPD were prescribed beta-blockers vs. 41% in those without COPD.
Chronic obstructive pulmonary disease is a frequent comorbidity in patients with HF and represents a significant healthcare burden to primary care. Although beta-blocker prescribing in the community has increased, less than a fifth of patients with HF and COPD received beta-blockers.
心力衰竭（HF）和慢性阻塞性肺疾病（COPD）经常同时存在，给医疗保健提供者带来了重大挑战。初级保健中 HF 和 COPD 患者的流行病学、咨询率和治疗情况尚不清楚。
这是对参与苏格兰连续发病记录计划的 61 个初级保健机构（377439 名患者）的横断面数据分析。HF 患者中 COPD 的患病率从 1999 年的 19.8%增加到 2004 年的 23.8%。2004 年，男性和女性的患病率相似（24.8%比 22.9%，P=0.09），随着年龄的增长到 75 岁，随着社会经济剥夺程度的增加而增加（最贫困的 31.3%比最不贫困的 18.6%，P=0.01）。同时患有两种疾病的患者的 HF 或 COPD 接触率大于仅患有一种疾病的患者的特定疾病接触率。尽管β受体阻滞剂的总体处方量随着时间的推移而增加；但 COPD 患者β受体阻滞剂处方的调整比值比仍然较低，并且没有改善[比值比 0.30（0.28-0.32），P<0.001]。2004 年，只有 18%的 HF 和 COPD 患者被开了β受体阻滞剂，而没有 COPD 的患者中有 41%被开了β受体阻滞剂。
慢性阻塞性肺疾病是 HF 患者的常见合并症，给初级保健带来了重大的医疗保健负担。尽管社区中β受体阻滞剂的处方有所增加，但只有不到五分之一的 HF 和 COPD 患者接受了β受体阻滞剂治疗。
