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 COPD or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute 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]ORadj, 95% CI: 1.10, 1.06-1.14 and ORadj, 95%CI: 0.85, 0.79-0.88). In patients who survived to discharge, referral to HF follow-up services differed between groups: COPD-HF patients had reduced odds of cardiology follow-up (ORadj, 95%CI 0.79, 0.77-0.81), whilst 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, whilst 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.