The prognostic influence of chronic obstructive pulmonary disease in patients hospitalised for chronic heart failure

Macchia, Alejandro; Monte, Simona; Romero, Marilena; D'Ettorre, A; Tognoni, Gianni

doi:10.1016/j.ejheart.2007.06.004

Cited by 101 publications

(79 citation statements)

References 37 publications

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“…Despite the fact that both diseases represent a major challenge for healthcare providers and share some common aetiological and epidemiological factors, there is a lack of relevant studies addressing the often ignored combination of CHF and COPD and still fewer addressing the simple clinical questions of interest to physicians [2][3][4][5][6][7][8][9][10][11]. Unfortunately, most studies of the coexistence of COPD and CHF have established diagnosis criteria in a retrospective way and, in most cases, the diagnoses were not based on spirometry and echocardiography [2,3,6,7,9,10].…”

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confidence: 99%

Unrecognised ventricular dysfunction in COPD

Macchia¹,

Moncalvo²,

Kleinert³

et al. 2011

European Respiratory Journal

133

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While both chronic congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) impose a substantial disease burden and share aetiological and epidemiological associations, they have largely been studied separately. The aim of our study was to assess the prevalence and the prognostic implications of the coexistence of left ventricular dysfunction in COPD patients and airway obstruction in CHF patients.We used a prospective cohort study including stable o60-yr-old patients with echocardiographically confirmed CHF (n5201) and stable o60-yr-old patients with clinically and spirometryconfirmed COPD (n5218). All CHF patients underwent routine spirometry, and all COPD patients underwent routine echocardiographic assessment and B-type natriuretic peptide (BNP) measurement. Patients were followed for 2 yrs.The prevalence of airway obstruction among CHF patients was 37.3% and the prevalence of ventricular dysfunction among COPD patients was 17%. The presence of ventricular dysfunction in patients with COPD tended to increase the risk of mortality during follow-up (hazard ratio 2.34, 95% CI 0.99-5.54; p50.053). The presence of airway obstruction in patients with CHF did not influence survival.CHF and COPD frequently coexist, and ventricular dysfunction worsens survival in patients with COPD. Considering the high prevalence and the prognostic implications of ventricular dysfunction, routine assessment with either BNP or echocardiogram should be considered in COPD patients.

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confidence: 99%

Unrecognised ventricular dysfunction in COPD

Macchia¹,

Moncalvo²,

Kleinert³

et al. 2011

European Respiratory Journal

133

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“…However, there are some studies revealing that coexisting COPD and CKD in HF patients is associated with higher mortality. Macchia et al [23] in an observational study on 1020 patients with CHF aged ≥ 60 years found that COPD was an independent short-term prognostic indicator of their mortality and cardiovascular comorbidity. According to the ADHERE registry, more than half of patients with all-cause AHF had at least moderate renal insufficiency (eGFR < 60 mL/min/1.73 m 2 ) on admission, which was associated with increased mortality [24].…”

Section: Discussionmentioning

confidence: 99%

Acute heart failure in patients admitted to the emergency department with acute myocardial infarction

et al. 2017

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A b s t r a c tBackground: Acute heart failure (AHF), occurring as a complication of ongoing acute myocardial infarction (AMI), is a common predictor of worse clinical outcome. Much less is known about the unique subpopulation of patients who present these two life-threatening conditions in the emergency department (ED). Aim:The aim of the study was to establish the prevalence of coexistence of AHF with AMI in the ED, to identify clinical factors associated with the higher prevalence of AHF at very early onset of AMI, and to assess the prognostic impact of the presence of AHF with AMI. Methods:A prospective study of 289 consecutive patients (mean age: 68 ± 11 years, 61% men) admitted to our institution (via the ED) with the diagnosis of AMI between May and October 2012 and followed-up for 2.5 years.Results: Acute heart failure was diagnosed in 13% of patients in the ED. In multivariable analysis, female sex, chronic obstructive pulmonary disease, and chronic kidney disease significantly increased the risk of developing AHF together with AMI (all p < 0.05). Patients with AHF were hospitalised for longer (9.2 ± 6.1 vs. 6.3 ± 4.5 days, p < 0.001), had higher in-hospital cardiovascular mortality (8% vs. 0%, p < 0.001), and all-cause (34% vs. 15%, p = 0.004) and cardiovascular mortality (26% vs. 9%, p = 0.002) during long-term follow-up. Conclusions:Despite good logistic-and evidence-based treatment, AHF is present in one in eight patients with AMI at the time of admission to the ED. Particularly poor outcomes characterise critically ill patients; therefore, great effort should be undertaken to improve their care.

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“…All diagnoses were coded according to the ICD-9 (Table 1). Information on the exposure to cardiovascular treatments was obtained from the prescriptions' database, considering the drugs identifying underlying clinical conditions, such as statins and treatments for hypertension and diabetes, as previously described [18][19][20][21] and indicated in Table 1.…”

Section: Outcome Evaluationmentioning

confidence: 99%

“…Data sources, such as hospital discharge records, prescription databases and mortality statistics, and the reliability of recordlinkage to produce epidemiological information have been validated and described elsewhere [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Antidepressants and cardiovascular outcomes in patients without known cardiovascular risk

Monte

Macchia

Romero

et al. 2009

Eur J Clin Pharmacol

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Purpose To identify a cohort of subjects without treatment for any cardiovascular risk and analyze the potential causative role of treatment for depression on the development of major cardiovascular outcomes during 2 years of follow-up. Methods We carried out a record-linkage analysis of hospital discharge records, prescription databases and vital statistics for all consecutive patients aged 30 years or older in one Italian region during a 4-year period. Depression was defined in terms of exposure to at least three prescriptions of antidepressant drugs within 1 year. Patients had no history of treatment with cardiovascular or antidiabetic agents and had not been hospitalized with a diagnosis of any cardiovascular condition in the preceding year. Followup was extended up to 2 years or to time to occurrence of major outcomes defined as either all-cause mortality, hospitalization for any cardiovascular cause or chronic exposure to cardiovascular drugs (antihypertensive, statins, antidiabetics). The results are expressed hazard ratios (HRs) and 95% confidence intervals (CIs) within age categories (30-49, 50-59, ≥60 years). Results A total of 105,573 persons without treated cardiovascular risk at baseline were identified, among whom 1,129(1.1%) had been chronically exposed to antidepressant treatment. Treated depression determined an increased risk of all cause-mortality (HR 1.88, 95% CI 1.33-2.66, p<0.001) and of subsequent treatment with antidiabetic agents (HR 0.89, 95% CI 1.34-2.66, p<0.001), statins (HR 1.87, 95% CI 1.53-2.29, p<0.001) and antihypertensive drugs (HR 1.25, 95% CI 1.07-1.47, p=0.006). Conclusion Among the general population without treated cardiovascular risk, pharmacologic treatment for depression was associated with an increase in all-cause mortality and major cardiovascular outcomes.

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The prognostic influence of chronic obstructive pulmonary disease in patients hospitalised for chronic heart failure

Cited by 101 publications

References 37 publications

Unrecognised ventricular dysfunction in COPD

Unrecognised ventricular dysfunction in COPD

Acute heart failure in patients admitted to the emergency department with acute myocardial infarction

Antidepressants and cardiovascular outcomes in patients without known cardiovascular risk

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