Tinè Mariaenrica, Bazzan Erica, Semenzato Umberto, Biondini Davide, Cocconcelli Elisabetta, Balestro Elisabetta, Casara Alvise, Baraldo Simonetta, Turato Graziella, Cosio Manuel G, Saetta Marina
Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy.
Meakins-Christie Laboratories, Respiratory Division, McGill University, Montreal, QC H4A3J1, Canada.
J Clin Med. 2020 Aug 14;9(8):2644. doi: 10.3390/jcm9082644.
Some 20% of patients with stable Chronic Obstructive Pulmonary Disease (COPD) might have heart failure (HF). HF contribution to acute exacerbations of COPD (AECOPD) presenting to the emergency department (ED) is not well established.
To assess (1) the HF incidence in patients presenting to the ED with AECOPD; (2) the concordance between ED and respiratory ward (RW) diagnosis; (3) the factors associated with risk of death after hospital discharge.
Retrospective chart review of 119 COPD patients presenting to ED for acute exacerbation of respiratory symptoms and then admitted to RW where a final diagnosis of AECOPD, AECOPD and HF and AECOPD and OD (other diagnosis), was obtained. ED and RW diagnosis were then compared. Factors affecting survival at follow-up were investigated.
At RW, 40.3% of cases were diagnosed of AECOPD, 40.3% of AECOPD and HF and 19.4% of AECOPD and OD, with ED diagnosis coinciding with RW's in 67%, 23%, and 57% of cases respectively. At RW, 60% of patients in GOLD1 had HF, of which 43% were diagnosed at ED, while 40% in GOLD4 had HF that was never diagnosed at ED. Lack of inclusion in a COPD care program, HF, and early readmission for AECOPD were associated with mortality.
HF is highly prevalent and difficult to diagnose in patients in all GOLD stages presenting to the ED with severe AECOPD, and along with lack of inclusion in a COPD care program, confers a high risk for mortality.
约20%的稳定期慢性阻塞性肺疾病（COPD）患者可能合并心力衰竭（HF）。HF对急诊科（ED）收治的慢性阻塞性肺疾病急性加重（AECOPD）的影响尚未明确。
评估（1）因AECOPD就诊于ED的患者中HF的发生率；（2）ED与呼吸病房（RW）诊断的一致性；（3）出院后死亡风险的相关因素。
回顾性查阅119例因呼吸道症状急性加重就诊于ED并随后收入RW的COPD患者病历，最终确诊为AECOPD、AECOPD合并HF以及AECOPD合并其他诊断（OD）。然后比较ED和RW的诊断结果。调查影响随访生存率的因素。
在RW，40.3%的病例被诊断为AECOPD，40.3%为AECOPD合并HF，19.4%为AECOPD合并OD，ED诊断与RW诊断的相符率分别为67%、23%和57%。在RW，GOLD1级患者中有60%合并HF，其中43%在ED被诊断出，而GOLD4级患者中有40%合并HF但从未在ED被诊断出。未纳入COPD护理计划、HF以及因AECOPD早期再入院与死亡率相关。
在因严重AECOPD就诊于ED的所有GOLD分级阶段的患者中，HF非常普遍且难以诊断，并且与未纳入COPD护理计划一起，会带来高死亡风险。
