Ivars N, Llorens Pere, Alquézar A, Jacob J, Rodríguez B, Guzmán M, Serrano Lázaro L, Martínez Picón M C, Cuevas Jiménez L, Miró Ò
Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Rev Clin Esp (Barc). 2024 Dec;224(10):634-645. doi: 10.1016/j.rceng.2024.10.003. Epub 2024 Oct 10.
This study aims to analyse differences in clinical and therapeutic management for patients with chronic obstructive pulmonary disease (COPD) who present to the emergency department with acute heart failure (AHF). Additionally, it examines mortality rates during such episodes.
We included patients diagnosed with AHF at 50 Spanish emergency departments from 2012 to 2022 who also had COPD. We compared their baseline characteristics, decompensation episodes, and emergency department management with those of AHF patients without COPD during the same period. We collected data on in-hospital and 30-day all-cause mortality, investigating differences between the two groups using crude and adjusted logistic regression models.
A total of 21,694 AHF patients were analysed (median age = 83 years, 56% female), including 4,942 (23%) with COPD. COPD patients were generally younger and more frequently male, with a higher prevalence of comorbidities (excluding valve disease and dementia, which were more common in non-COPD patients). They exhibited a worse respiratory functional class (NYHA) but a better overall functional capacity (Barthel Index). Decompensation in COPD patients was more often triggered by infection and less frequently by tachyarrhythmia, hypertensive crisis, or acute coronary syndrome. While there were differences in clinical findings in the emergency department, the severity assessed by the MEESSI-AHF Scale was similar across both groups. In terms of emergency department management, a higher proportion of COPD patients received oxygen therapy, non-invasive ventilation, bronchodilators, corticosteroids, and antibiotics, while fewer received intravenous nitroglycerin, and they were hospitalized more frequently. In-hospital mortality rates were 8.1% for patients with COPD and 7.5% for those without (OR = 1.088, 95% CI = 0.968-1.224), with 30-day mortality rates of 11.0% and 10.0%, respectively (OR = 1.111, 95% CI = 1.002-1.231). After adjusting for clinical characteristics, decompensation episodes, and emergency department management, these odds ratios decreased to 1.040 (95% CI = 0.905-1.195) and 1.080 (95% CI = 0.957-1.219), respectively.
Patients with AHF and COPD exhibit distinct clinical and therapeutic management characteristics in the emergency department and require more frequent hospitalization. Although they show higher crude 30-day mortality, this is attributable to their differing clinical profiles rather than the presence of COPD itself.
本研究旨在分析因急性心力衰竭（AHF）就诊于急诊科的慢性阻塞性肺疾病（COPD）患者在临床和治疗管理方面的差异。此外，还研究此类发作期间的死亡率。
我们纳入了2012年至2022年在西班牙50个急诊科被诊断为AHF且患有COPD的患者。我们将他们的基线特征、失代偿发作情况和急诊科管理与同期无COPD的AHF患者进行了比较。我们收集了院内和30天全因死亡率的数据，使用粗逻辑回归模型和调整后的逻辑回归模型研究两组之间的差异。
共分析了21,694例AHF患者（中位年龄 = 83岁，56%为女性），其中4,942例（23%）患有COPD。COPD患者通常更年轻，男性更常见，合并症患病率更高（不包括瓣膜病和痴呆，这在非COPD患者中更常见）。他们的呼吸功能分级（NYHA）较差，但总体功能能力（Barthel指数）较好。COPD患者的失代偿更常由感染引发，而由快速心律失常、高血压危象或急性冠状动脉综合征引发的频率较低。虽然急诊科的临床发现存在差异，但两组通过MEESSI-AHF量表评估的严重程度相似。在急诊科管理方面，更高比例的COPD患者接受了氧疗、无创通气、支气管扩张剂、皮质类固醇和抗生素治疗，而接受静脉注射硝酸甘油的患者较少，且他们住院的频率更高。COPD患者的院内死亡率为8.1%，无COPD患者为7.5%（OR = 1.088，95% CI = 0.968 - 1.224），30天死亡率分别为11.0%和10.0%（OR = 1.111，95% CI = 1.002 -
1.231）。在调整临床特征、失代偿发作情况和急诊科管理后，这些比值比分别降至1.040（95% CI = 0.905 - 1.195）和1.080（95% CI = 0.957 - 1.219）。
AHF合并COPD的患者在急诊科表现出独特的临床和治疗管理特征，需要更频繁住院。尽管他们的30天粗死亡率较高，但这归因于他们不同的临床特征，而非COPD本身的存在。
