Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy.
Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy.
Eur J Intern Med. 2019 Feb;60:31-38. doi: 10.1016/j.ejim.2018.11.002. Epub 2018 Nov 13.
Chronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of β-blockers at discharge and mortality in patients with COPD.
We studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality.
After adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06-1.47; p = .007). The relative risk of death for COPD patients increased steeply from 30 to 180 days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of β-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53-0.83; p ≤.001).
Our data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of β-blockers at discharge is independently associated with improved survival in ADHF patients with COPD.
慢性阻塞性肺疾病（COPD）是心力衰竭住院患者最常见的合并症之一，通常与不良结局相关。然而，先前关于死亡率增加和风险轨迹的研究结果并不一致。我们旨在评估 COPD 在急性失代偿性心力衰竭（ADHF）患者中的预后影响，并研究 COPD 患者出院时使用β受体阻滞剂与死亡率之间的关联。
我们研究了 1530 名患者。在调整后的 Fine-Gray 比例风险模型中，评估 COPD 与死亡率的关系，其中心脏移植和心室辅助装置植入被视为竞争风险。主要结局是 5 年全因死亡率。
在调整了既定的风险标志物后，与非 COPD 患者相比，COPD 患者的 5 年死亡率的亚分布风险比（SHR）为 1.25（95%置信区间[CI] 1.06-1.47；p=0.007）。COPD 患者的死亡相对风险从 30 天急剧增加到 180 天，并且在整个随访期间仍然明显较高。在合并 COPD 的患者中，出院时使用β受体阻滞剂与显著降低 1 年出院后死亡率相关（SHR 0.66，95%CI 0.53-0.83；p≤0.001）。
我们的数据表明，合并 COPD 的 ADHF 患者的长期生存率比没有合并 COPD 的患者差。大部分超额死亡率发生在住院后几个月内。我们的数据还表明，出院时使用β受体阻滞剂与 COPD 合并 ADHF 患者的生存改善独立相关。
