Kostikas Konstantinos, Rhee Chin Kook, Hurst John R, Agostoni Piergiuseppe, Cao Hui, Fogel Robert, Jones Rupert, Kocks Janwillem W H, Mezzi Karen, Wan Yau Ming Simon, Ryan Ronan, Price David B
Novartis Pharma AG, Basel, Switzerland.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Pragmat Obs Res. 2020 Jun 2;11:55-66. doi: 10.2147/POR.S250451. eCollection 2020.
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) often occur concomitantly, presenting diagnostic and therapeutic challenges for clinicians. We examined the characteristics of patients prescribed adequate versus inadequate therapy within 3 months after newly diagnosed comorbid COPD or HF.
Eligible patients in longitudinal UK electronic medical record databases had pre-existing HF and newly diagnosed COPD (2017 GOLD groups B/C/D) or pre-existing COPD and newly diagnosed HF. Adequate COPD therapy was defined as long-acting bronchodilator(s) with/without inhaled corticosteroid; adequate HF therapy was defined as beta-blocker plus angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker.
Of 2439 patients with HF and newly diagnosed COPD (mean 75 years, 61% men), adequate COPD therapy was prescribed for 726 (30%) and inadequate for 1031 (42%); 682 (28%) remained untreated for COPD. Adequate (vs inadequate) COPD therapy was less likely for women (35%) than men (45%), smokers (36%) than ex-/non-smokers (45%), and non-obese (41%) than obese (47%); spirometry was recorded for 57% prescribed adequate versus 35% inadequate COPD therapy. Of 12,587 patients with COPD and newly diagnosed HF (mean 75 years, 60% men), adequate HF therapy was prescribed for 2251 (18%) and inadequate for 5332 (42%); 5004 (40%) remained untreated for HF. Adequate (vs inadequate) HF therapy was less likely for smokers (27%) than ex-/non-smokers (32%) and non-obese (30%) than obese (35%); spirometry was recorded for 65% prescribed adequate versus 39% inadequate HF therapy.
Many patients with comorbid COPD/HF receive inadequate therapy after new diagnosis. Improved equity of access to integrated care is needed for all patient subgroups.
慢性阻塞性肺疾病（COPD）和心力衰竭（HF）常同时出现，给临床医生带来诊断和治疗挑战。我们研究了新诊断为合并COPD或HF后3个月内接受充分治疗与不充分治疗的患者特征。
英国纵向电子病历数据库中的符合条件患者患有既往HF和新诊断的COPD（2017年GOLD分级B/C/D组）或既往COPD和新诊断的HF。充分的COPD治疗定义为使用长效支气管扩张剂加/不加吸入性糖皮质激素；充分的HF治疗定义为β受体阻滞剂加血管紧张素转换酶抑制剂和/或血管紧张素受体阻滞剂。
在2439例患有HF和新诊断COPD的患者（平均75岁，61%为男性）中，726例（30%）接受了充分的COPD治疗，1031例（42%）治疗不充分；682例（28%）未接受COPD治疗。女性（35%）比男性（45%）、吸烟者（36%）比已戒烟者/非吸烟者（45%）、非肥胖者（41%）比肥胖者（47%）接受充分（与不充分相比）COPD治疗的可能性更小；接受充分COPD治疗的患者中有57%进行了肺功能测定，而治疗不充分的患者中这一比例为35%。在12587例患有COPD和新诊断HF的患者（平均75岁，60%为男性）中，2251例（18%）接受了充分的HF治疗，5332例（42%）治疗不充分；5004例（40%）未接受HF治疗。吸烟者（27%）比已戒烟者/非吸烟者（32%）、非肥胖者（30%）比肥胖者（35%）接受充分（与不充分相比）HF治疗的可能性更小；接受充分HF治疗的患者中有65%进行了肺功能测定，而治疗不充分的患者中这一比例为39%。
许多合并COPD/HF的患者在新诊断后接受的治疗不充分。所有患者亚组都需要改善获得综合治疗的公平性。
