Hesse Kerrick, Bourke Stephen, Steer John
Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, UK.
Department of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
Respir Med. 2022 May;196:106800. doi: 10.1016/j.rmed.2022.106800. Epub 2022 Mar 2.
Patients surviving hospitalization for exacerbations of chronic obstructive pulmonary disease (ECOPD) are at heightened risk of cardiovascular events. Heart failure is often underdiagnosed and undertreated in COPD; better care could improve outcome. We aimed to capture contemporary investigation and management of heart failure (HF) in patients hospitalized with ECOPD.
In two UK hospitals, patients admitted with ECOPD between 2017 and 2020 were retrospectively identified. Baseline characteristics between known, newly diagnosed and no HF were compared using analysis of variance and chi-squared test. Impact of HF on mortality was assessed by Kaplan-Meier analysis and Cox proportional-hazards regression. Sensitivity and specificity of NT-proBNP for diagnosing HF at recognized thresholds were reported.
On admission, 94/476 (19.7%) patients had known HF. Among remaining patients, 89/382 (23.3%) were investigated within 100 days of admission, confirming HF in 38. Of 33 patients with heart failure with reduced ejection fraction (HFrEF), 18 (54.5%) were prescribed ACE-inhibitor and B-blocker. 77/132 patients (58.3%) with HF and 108/344 patients (31.4%) without HF died (adjusted HR 2.03, 95% CI 1.46-2.82, p < 0.001) during follow up (median 11.7 months). At ≥400 pg/mL, NPV and PPV of NT-proBNP for the diagnosis of HF were 77.8% and 82.8%.
A new diagnosis of HF was made in over 40% investigated. In patients with coexistent HF, undertreatment was common and 1-year mortality exceeded 50%. NT-proBNP may help identify patients who need cardiovascular functional imaging. Research to improve HF diagnosis and treatment in hospitalized ECOPD is urgently needed.
因慢性阻塞性肺疾病急性加重（ECOPD）住院存活的患者发生心血管事件的风险增加。慢性阻塞性肺疾病（COPD）患者中心力衰竭常常诊断不足且治疗不充分；更好的治疗可能改善预后。我们旨在了解ECOPD住院患者心力衰竭（HF）的当代调查和管理情况。
在英国的两家医院，对2017年至2020年间因ECOPD入院的患者进行回顾性识别。使用方差分析和卡方检验比较已知、新诊断和无HF患者的基线特征。通过Kaplan-Meier分析和Cox比例风险回归评估HF对死亡率的影响。报告NT-proBNP在公认阈值下诊断HF的敏感性和特异性。
入院时，94/476（19.7%）患者已知患有HF。在其余患者中，89/382（23.3%）在入院100天内接受了检查，其中38例确诊为HF。在33例射血分数降低的心力衰竭（HFrEF）患者中，18例（54.5%）接受了ACE抑制剂和β受体阻滞剂治疗。随访期间（中位时间11.7个月），77/132例（58.3%）有HF的患者和108/344例（
