Dataset Information

Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis.

ABSTRACT:

Objective

To evaluate the association between having concomitant chronic obstructive pulmonary disease (COPD) or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute heart failure (HF).

Setting

Data were obtained from patients enrolled in the National Heart Failure Audit.

Participants

217 329 patients hospitalised for HF in England-Wales between March 2012 and 2018.

Outcomes

In-hospital mortality, referrals to cardiology follow-up and prescriptions for HF medications were compared between patients with comorbid COPD (COPD-HF) or asthma (asthma-HF) versus HF-alone using mixed-effects logistic regression.

Results

Patients with COPD-HF were more likely to die during hospitalisation, and those with asthma-HF had a reduced likelihood of death, compared with patients who had HF-alone ((adjusted)OR_adj, 95% CI: 1.10, 1.06 to 1.14 and OR_adj, 95% CI: 0.84, 0.79 to 0.88). In patients who survived to discharge, referral to HF follow-up services differed between groups: patients with COPD-HF had reduced odds of cardiology follow-up (OR_adj, 95% CI 0.79, 0.77 to 0.81), while cardiology referral odds for asthma-HF were similar to HF-alone. Overall, proportions of HF medication prescriptions at discharge were low for both COPD-HF and asthma-HF groups, particularly prescriptions for beta-blockers.

Conclusions

In this nationwide analysis, we showed that COPD and asthma significantly impact the clinical course in patients hospitalised for HF. COPD is associated with higher in-patient mortality and lower cardiology referral odds, while COPD and asthma are both associated with lower use of prognostic HF therapies on discharge. These data highlight therapeutic gaps and a need for better integration of cardiopulmonary services to improve healthcare provision for patients with HF and coexisting respiratory disease.

SUBMITTER: Gulea C

PROVIDER: S-EPMC9247695 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis.

Gulea Claudia C Zakeri Rosita R Kallis Constantinos C Quint Jennifer K JK

BMJ open 20220630 6

<h4>Objective</h4>To evaluate the association between having concomitant chronic obstructive pulmonary disease (COPD) or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute heart failure (HF).<h4>Setting</h4>Data were obtained from patients enrolled in the National Heart Failure Audit.<h4>Participants</h4>217 329 patients hospitalised for HF in England-Wales between March 2012 and 2018.<h4>Outcomes</h4>In-hospital mortality, referrals to cardiolog ...[more]

PMID: 35772828

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Project description:IntroductionReadmissions are a recognised challenge for providers of healthcare and incur financial penalties in a growing number of countries. However, the scale of unscheduled hospital contacts including attendances at emergency departments that do not result in admission is not well known. In addition, little is known about the route to readmission for patients recently discharged from an emergency hospital stay.MethodsThis is an observational study of national hospital administration data for England. In this retrospective cohort study, we tracked patients for 30 days after discharge from an emergency admission for heart failure (HF) or chronic obstructive pulmonary disorder (COPD).ResultsThe majority of patients (COPD:79%; HF:75%) had no unscheduled contact with secondary health care within 30 days of discharge. Of those who did have unscheduled contact, the most common first unscheduled contact was emergency department (ED) attendance (COPD:16%; HF:18%). A further 5% of COPD patients and 4% of HF patients were admitted for an emergency inpatient stay, but not through the ED. A small percentage of patients (COPD:<1%, HF:2%) died without any known contact with secondary care. ED conversion rates at first attendance for both COPD and HF were high: 75% and 79% respectively. A quarter of patients who were not admitted during this first ED attendance attended the ED again within the 30-day follow-up period, and around half (COPD:56%; HF:63%) of these were admitted at this point. Patients who live alone, had an index admission which included an overnight stay and were comorbid had higher odds of being admitted through the ED than via other routes.ConclusionWhile the majority of patients did not have unscheduled contact with secondary care in the 30 days after index discharge, many patients attended the ED, often multiple times, and many were admitted to hospital, not always via the ED. More frail patients were more likely to be admitted through the ED, suggesting a possible area of focus as discharge bundles are developed.

Dataset Information

Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis.

Objective

Setting

Participants

Outcomes

Results

Conclusions

Publications

Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis.

Similar Datasets

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