Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis

Abstract

Background: Discrepancy exists amongst studies investigating the effect of comorbid heart failure (HF) on the morbidity and mortality of chronic obstructive pulmonary disease (COPD) patients. Methods: MEDLINE and Embase were searched using a pre-specified search strategy for studies comparing hospitalisation, rehospitalisation, and mortality of COPD patients with and without HF. Studies must have reported crude and/or adjusted rate ratios, risk ratios, odds ratios (OR), or hazard ratios (HR). Results: Twenty-eight publications, reporting 55 effect estimates, were identified that compared COPD patients with HF with those without HF. One study reported on all-cause hospitalisation (1 rate ratio). Two studies reported on COPD-related hospitalisation (1 rate ratio, 2 OR). One study reported on COPD-or cardiovascular-related hospitalisation (4 HR). One study reported on 90-day all-cause rehospitalisation (1 risk ratio). One study reported on 3-year all-cause rehospitalisation (2 HR). Four studies reported on 30-day COPD-related rehospitalisation (1 risk ratio; 5 OR). Two studies reported on 1-year COPD-related rehospitalisation (1 risk ratio; 1 HR). One study reported on 3year COPD-related rehospitalisation (2 HR). Eighteen studies reported on all-cause mortality (1 risk ratio; 4 OR; 24 HR). Five studies reported on all-cause inpatient mortality (1 risk ratio; 4 OR). Meta-analyses of hospitalisation and rehospitalisation were not possible due to insufficient data for all individual effect measures. Meta-analysis of studies requiring spirometry for the diagnosis of COPD found that risk of all-cause mortality was 1.61 (pooled HR; 95%CI: 1.38, 1.83) higher in patients with HF than in those without HF. Conclusions: In this systematic review, we investigated the effect of HF comorbidity on hospitalisation and mortality of COPD patients. There is substantial evidence that HF comorbidity increases COPD-related rehospitalisation and all-cause mortality of COPD patients. The effect of HF comorbidity may differ depending on COPD phenotype, HF type, or HF severity and should be the topic of future research.

Evaluating the impact of chronic obstructive pulmonary disease on in‐hospital outcomes following left ventricular assist device implantation

“…Additionally, COPD can lead to PHTN, with subsequent right heart failure 15,16 . Patients with either COPD or HF have a greater proportion of all‐cause hospitalizations and mortality, with an increased risk when COPD is associate with HF 17,18 . In spite of this reported increased morbidity and mortality, individuals with COPD are less likely than non‐COPD patients to be prescribed evidence‐based pharmacological HF therapies 19‐21 .…”

“…15,16 Patients with either COPD or HF have a greater proportion of all-cause hospitalizations and mortality, with an increased risk when COPD is associate with HF. 17,18 In spite of this reported increased morbidity and mortality, individuals with COPD are less likely than non-COPD patients to be prescribed evidence-based pharmacological HF therapies. [19][20][21] There is a There is a rapidly growing number of individuals with AHF with a mortality that could be as high as 80% at 1 year.…”

From systemic effects of COPD to COPD as pulmonary component of multimorbidity

“…COPD is frequent and often undiagnosed (and hence untreated) among patients with chronic HF, at rates of 13 to 39% 56 . Moreover, COPD is associated with higher mortality in patients with chronic HF 58 . Similarly, the prevalence of COPD is high among patients with established IHD, but, as in chronic HF, is grossly underdiagnosed 56,59 .…”

Effects of Inhaled Corticosteroids on Hospitalized Chronic Obstructive Pulmonary Disease Exacerbations: A Retrospective, Multicenter, Propensity Score-Matched Study in China

“…[3] Nevertheless, a meta-analysis of randomized controlled trials showed that the treatment with budesonide-an inhaled corticosteroid (ICS)-did not increase the risk of pneumonia. [5] Right heart failure is a common and serious complication in patients with COPD, which, when combined with right heart failure, can increase hospitalization rates [6,7] and all-cause mortality. [7][8][9][10] Recent studies showed that patients with both COPD and right heart failure may bene t from glucocorticoids.…”

“…[5] Right heart failure is a common and serious complication in patients with COPD, which, when combined with right heart failure, can increase hospitalization rates [6,7] and all-cause mortality. [7][8][9][10] Recent studies showed that patients with both COPD and right heart failure may bene t from glucocorticoids. In a real-world study with a 9year follow-up, the use of either ICS alone or long-acting beta-agonist (LABA)-ICS improved overall survival in patients with COPD.…”