Even after adjusting for other risk factors, patients with COPD were more likely to be readmitted to the hospital with heart failure following an acute myocardial infarction, or heart attack.
People with chronic obstructive pulmonary disease (COPD) face a significantly higher risk of hospitalization from heart failure after an acute myocardial infarction (AMI), a new study has found.
The results highlight the need for careful management of these patients, both in the hospital and after discharge, according to the authors. The study was published in Archives of Medical Science Atherosclerotic Diseases.
As more and more people survive AMI, the number of patients living with heart failure has increased, wrote the study authors. Patients who experience heart failure after AMI face a worse prognosis and significantly higher mortality rates than patients without heart failure following AMI.
COPD is also associated with a higher risk of mortality and is itself a risk factor for cardiovascular disease, the authors said.
“Patients with COPD who have AMI are less aggressively treated than those without COPD, which results in increased in-hospital mortality as well as long-term mortality,” they wrote.
Previous research shows a higher risk of post–heart attack heart failure in patients with COPD, but the present stud investigators said most of the existing research on the matter is older, used small sample sizes, or had other significant limitations.
“There is a dearth of recent, population-level research addressing differences in heart failure hospitalizations based on COPD status among [an] all-comers cohort of AMI survivors in the United States,” they said.
The investigators decided to fill the research gap by pulling data from the US Nationwide Readmissions Database. They identified 237,549 adults who survived an AMI between January and June of 2014. They then looked at which patients also had COPD (17.5%). These patients were more likely to be female, older, and have cardiac comorbidities, the authors said.
When the authors compared those patients with COPD to the rest of the AMI survivors, they found significant differences in outcomes. Patients with COPD had an in-hospital heart failure rate of 47.0% compared with 25.4% for patients without COPD (P < .001). Heart failure hospitalization within 6 months of an AMI was also higher in the COPD group (9.4% vs 4.6%; odds ratio [OR], 2.14; 95% CI, 2.01-2.29; P < .001). The authors said a risk-adjusted multivariate analysis erased some of that gap, but not all of it.
“Patients with COPD had worse baseline characteristics, in-hospital outcomes, and lower revascularization rates, but the increased heart failure hospitalization risk in COPD patients persisted (although attenuated) even after adjusting for these differences,” they said.
The risk-adjusted OR of 6-month heart failure hospitalization was 1.39 (95% CI, 1.30-1.49). People with COPD were more likely to die during a heart failure hospitalization (5.7% vs 4.2% (P < .001), the authors said.
Finally, a composite outcome that combined in-hospital heart failure or 6-month heart failure hospitalization found people with COPD had a 49.0% risk compared with 26.9% in the non-COPD group (P < .001).
The authors said their results highlight the importance of improving AMI care in COPD and of early recognition of heart failure in patients with AMI.
“These findings underscore the importance of improving AMI care in patients with COPD and highlight the need for closer follow-up, careful monitoring for the development of HF, and co-management of COPD patients following an AMI to prevent the onset of HF requiring hospitalization,” they wrote.
Reference
Yandrapalli S, Pandit M, Malik A, et al. Impact of chronic obstructive pulmonary disease on heart failure hospitalizations after an acute myocardial infarction. Arch Med Sci Atheroscler Dis. Published online March 30, 2023. doi:10.5114/amsad/162014
Real-World Data Show Sotorasib Effective for NSCLC With KRAS Mutation
May 18th 2024Data from real-world and clinical-trial settings on frontline monotherapy treatment with the KRAS inhibitor sotorasib both show similar progression-free survivals and a high likelihood that the treatment’s efficacy is not affected with dose reduction.
Read More
Health Equity and Access Weekly Roundup: May 18, 2024
May 18th 2024The US Senate hosted a panel addressing physician and health care shortages and efforts to increase minority representation in the medical field. An expert discussed initiatives to prevent senior homelessness. Advocates called for the repeal of the Comstock Act. Regulatory reforms are called for to improve rural cancer patients' access to pharmacies. Research reveals the impact of denials on patient access to immunology treatments.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Study Highlights Significant Increases in Utilization, Spending on DMD Drugs in Medicaid
May 17th 2024The findings add to recent research on the growing utilization, expenditure, and prices of Duchenne muscular dystrophy (DMD) therapies in the current landscape, an area health care policy could potentially address.
Read More