Interplay between acute heart failure and COPD in patients hospitalized for dyspnea: prognostic insights from the paradise cohort
G B Baudry, L Ferreira, L M Monzo, C L Lacomblez, E M Bresso, K V Duarte, F B Boutry, C D Duchanois, D J Jaeger, A M Mebazaa, F Z Zannad, T C Chouihed, N C GirerdAbstract
Introduction
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are major public health challenges that frequently coexist, largely due to shared risk factors. This study aims to investigate the interplay between these two conditions in acute setting with respect to in-hospital and 5-year mortality, and to assess the prognostic impact of their coexistence in patients admitted for dyspnea in the Emergency Department.
Methods
We analyzed 9,278 consecutive patients (50% male; mean age, 80 years) hospitalized for decompensated COPD or HF following an emergency department visit for dyspnea between January 2010 and December 2019, within the PARADISE cohort (PAthwAy of Dyspneic patIent in Emergency; NCT02800122). Patients were classified into three groups: HF only (n=5,287), COPD only (n=2,629), and concomitant HF and COPD (n=1,301). The primary outcome was in-hospital mortality. The secondary outcome was five-year mortality among patients discharged alive after the index hospitalization.
Results
The primary outcome of in-hospital mortality occurred in 16.2% of patients with heart failure (HF), 5.5% of those with COPD, and 13.1% of patients with concomitant HF and COPD. Among patients discharged alive, 5-year mortality was 53.1% in the HF group, 49.0% in the COPD group, and 57.4% in the concomitant HF and COPD group. Using HF as the reference category, the adjusted odds ratio for in-hospital mortality was 0.47 (95% confidence interval [CI] 0.36–0.61; p<0.001) in patients with COPD alone and 0.86 (95% CI 0.68–1.09; p=0.20) in patients with concomitant HF and COPD.
For 5-year mortality, the adjusted hazard ratio was 0.95 (95% CI 0.86–1.05; p=0.30) for patients with COPD alone and 1.03 (95% CI 0.93–1.13; p=0.60) for patients with concomitant HF and COPD.
Conclusion
Acute HF was the primary determinant of in-hospital prognosis, with patients presenting with HF—whether or not associated with COPD—exhibiting similar short-term mortality, whereas COPD alone was associated with a lower in-hospital risk. In contrast, long-term mortality among survivors did not differ significantly according to HF or COPD status