Evaluating the role of COPD in patients with heart failure using multiple electronic health data sources
Author(s)
Gulea, Claudia-Stana
Type
Thesis
Abstract
Heart failure (HF) and COPD frequently co-exist. Shared symptoms and risk factors make diagnosis and management difficult and current understanding of the relationship between the diseases is limited.
I used several electronic healthcare record (EHR) data sources, from the United States (US) and the United Kingdom (UK) to evaluate the impact of COPD on outcomes in patients with HF.
First, I aimed to demonstrate that comorbidity data from EHR can be used to derive meaningful clusters in patients with chronic HF, expecting COPD to be a main driver of this phenotyping endeavour. Second, I compared outcomes (hospitalisation, mortality, healthcare utilisation) in patients with COPD-HF, between left ventricular ejection fraction (LVEF) groups. Third, I pooled data from previously published studies to assess the overall effect of HF management (beta-blockers) on outcomes in COPD. In a fourth study I examined whether COPD was associated with in-hospital mortality and management of patients hospitalised for HF and assessed association with LVEF. Lastly, I investigated whether COPD affected readmission in a population of patients hospitalised for HF.
This work provides evidence to suggest that while COPD may not play a major role in determining a HF classification system based on comorbidities only, it affects clinical outcomes in the long-term, particularly for chronic HFpEF patients. Conversely, HF management such as beta-blockers does not appear to worsen outcomes in COPD patients. In the acute setting, coexisting COPD is independently associated with increased in-hospital mortality and decreased HF medication prescription and access to healthcare services amongst patients who survived their first HF admission. Readmission risk is higher amongst those with HF and COPD compared with HF-alone, though the most frequent reason for returning to hospital is still due to a cardiovascular cause.
I used several electronic healthcare record (EHR) data sources, from the United States (US) and the United Kingdom (UK) to evaluate the impact of COPD on outcomes in patients with HF.
First, I aimed to demonstrate that comorbidity data from EHR can be used to derive meaningful clusters in patients with chronic HF, expecting COPD to be a main driver of this phenotyping endeavour. Second, I compared outcomes (hospitalisation, mortality, healthcare utilisation) in patients with COPD-HF, between left ventricular ejection fraction (LVEF) groups. Third, I pooled data from previously published studies to assess the overall effect of HF management (beta-blockers) on outcomes in COPD. In a fourth study I examined whether COPD was associated with in-hospital mortality and management of patients hospitalised for HF and assessed association with LVEF. Lastly, I investigated whether COPD affected readmission in a population of patients hospitalised for HF.
This work provides evidence to suggest that while COPD may not play a major role in determining a HF classification system based on comorbidities only, it affects clinical outcomes in the long-term, particularly for chronic HFpEF patients. Conversely, HF management such as beta-blockers does not appear to worsen outcomes in COPD patients. In the acute setting, coexisting COPD is independently associated with increased in-hospital mortality and decreased HF medication prescription and access to healthcare services amongst patients who survived their first HF admission. Readmission risk is higher amongst those with HF and COPD compared with HF-alone, though the most frequent reason for returning to hospital is still due to a cardiovascular cause.
Version
Open Access
Date Issued
2021-08
Date Awarded
2021-12
Copyright Statement
Creative Commons Attribution NonCommercial Licence
Advisor
Quint, Jennifer
Zakeri, Rosita
Sponsor
National Heart & Lung Institute
Grant Number
National Heart & Lung Institute Studentship
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)