A75-05 Real-World Impact on Mortality of Guideline-Directed Medical Therapy in Patients With Heart Failure Hospitalized for COPD Exacerbation

Rationale

Evidence on the effectiveness of cardiovascular drugs and of long-acting β-agonists (LABA) in combination with long-acting muscarinic antagonists (LAMA) in patients with heart failure (HF) hospitalized for acute exacerbation of COPD (ECOPD) is limited. Therefore we investigated associations of using guideline-directed medical therapy (GDMT) for HF and/or COPD during hospitalization with in-hospital mortality and post-discharge cardiopulmonary risk.

Methods

This Belgian nationwide observational cohort included adult patients with HF hospitalized for ECOPD between 2017-2022. GDMT for HF was defined as use of β-blockers in combination with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors following 2016 European Society of Cardiology guidelines, whereas GDMT for COPD was defined as use of at least LABA+LAMA with or without inhaled corticosteroids (ICS) following 2017 Global Initiative for Chronic Obstructive Lung Disease report. Patients were categorized into four mutually exclusive groups: no GDMT, HF GDMT only, COPD GDMT only and GDMT for both diseases. The association of GDMT with in-hospital all-cause-mortality and post-discharge cardiopulmonary risk (composite outcome of all-cause mortality and cause-specific readmission for COPD, heart failure, ischemic heart diseases, pulmonary heart diseases, arrythmias and cerebrovascular diseases) was investigated using multivariable logistic regression and time-dependent (30-day-splitted) Cox models respectively.

Results

Among 14,582 patients (mean age 76.8 years, 40.7% females), GDMT was dispensed for HF only (20.4%), COPD only (23.6%) or both HF and COPD (11.9%). During hospitalization, 14.1% (2,058/14,582) died: 18.1% in the no GDMT group, 11.1% in the HF GDMT group, 11.0% in COPD GDMT group and 7.9% in the group using both GDMT. Compared with no GDMT use, HF GDMT (adjusted odds ratio (aOR) 0.59, 95% confidence interval (CI) 0.51-0.67), COPD GDMT (aOR 0.57, 95%CI 0.50-0.65) and GDMT for both diseases (aOR 0.40, 95%CI 0.33-0.49) were associated with lower in-hospital mortality. In addition, ICS and mineralocorticoid receptor antagonists (MRA) were independently associated with a decreased odds of in-hospital mortality (aOR 0.80, 95%CI 0.72-0.89 and 0.79, 95% CI 0.71-0.89 respectively). Both GDMT for HF (aHR 0.82, 95%CI 0.71-0.94) and for COPD (aHR 0.87, 95% CI 0.76-1.00) reduced post-discharge cardiopulmonary risk <30 days (while MRA and ICS no longer significantly did), and only GDMT for HF was significantly associated with a lower post-discharge cardiopulmonary risk ≥30 days (aHR 0.89, 95%CI 0.85-0.94).

Conclusions

These results highlight the importance of GDMT for both COPD and HF during a hospitalized ECOPD to reduce in-hospital mortality, and of GDMT for HF to improve long-term outcomes.

This abstract is funded by: None