Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both
Ernesto Crisafulli, Giulia Sartori, Alice Vianello, Fabiana Busti, Alessandro Nobili, Pier Mannuccio Mannucci, Domenico Girelli, REPOSI Investigators, Pier Mannuccio Mannucci, Giorgio Sesti, Antonello Pietrangelo, Francesco Perticone, Francesco Violi, Salvatore Corrao, Alessandra Marengoni, Mauro Tettamanti, Luca Pasina, Carlotta Franchi, Pier Mannuccio Mannucci, Alessandro Nobili, Giorgio Sesti, Antonello Pietrangelo, Francesco Perticone, Francesco Violi, Salvatore Corrao, Alessandra Marengoni, Mauro Tettamanti, Luca Pasina, Carlotta Franchi, Carlotta Franchi, Alessio Novella, Mauro Tettamanti, Gabriella Miglio, Mauro Tettamanti, Alessia Antonella Galbussera, Ilaria Ardoino, Alessio Novella, Domenico Prisco, Elena Silvestri, Giacomo Emmi, Alessandra Bettiol, Irene Mattioli, Gianni Biolo, Michela Zanetti, Giacomo Bartelloni, Michele Zaccari, Massimiliano Chiuch, M. Vanoli, Giulia Grignani, E.A. Pulixi, Matteo Pirro, Graziana Lupattelli, Vanessa Bianconi, Riccardo Alcidi, Alessia Giotta, Massimo R. Mannarino, Domenico Girelli, Fabiana Busti, Giacomo Marchi, Mario Barbagallo, Ligia J. Domínguez, Vincenza Beneduce, Federica Cacioppo, Salvatore Corrao, Giuseppe Natoli, Salvatore Mularo, Massimo Raspanti, Christiano Argano, Federica Cavallaro, Marco Zoli, Maria Laura Matacena, Giuseppe Orio, Eleonora Magnolfi, Giovanni Serafini, Angelo Simili, Mattia Brunori, Ilaria Lazzari, Angelo Simili, Maria Domenica Cappellini, Giovanna Fabio, Margherita Migone De Amicis, Giacomo De Luca, Natalia Scaramellini, Valeria Di Stefano, Simona Leoni, Sonia Seghezzi, Alessandra Danuta Di Mauro, Diletta Maira, Marta Mancarella, Tiziano Lucchi, Paolo Rossi, Marta Clerici, Simona Leoni, Alessandra Danuta Di Mauro, Giulia Bonini, Federica Conti, Silvia Prolo, Maddalena Fabrizi, Miriana Martelengo, Giulia Vigani
Abstract
BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. METHODS: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. RESULTS: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). CONCLUSION: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population.