Prevalence, Health Care Burden, and Longitudinal Outcomes of Chronic Obstructive Pulmonary Disease Among People With Heart Failure

Abstract

Background

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common comorbidities. We aimed to assess health care resource use and outcomes associated with COPD in patients hospitalized for HF.

Methods

This was an exploratory cohort analysis of patients hospitalized for HF and enrolled in the Patient-Centered Care Transitions in HF cluster-randomized trial. The primary outcome was all-cause mortality. Secondary outcomes included all-cause and HF hospitalization, health care resource use, and direct health care costs. Survival was evaluated using Cox proportional hazards models adjusted for baseline variables.

Results

Among 4441 patients discharged alive, 1136 (25.6%) had COPD at baseline. All-cause mortality was higher at 5 years among patients with vs without COPD (75.2% vs 60.9%, adjusted hazard ratio 1.29, 95% confidence interval 1.19-1.40). Patients with COPD had more frequent all-cause rehospitalizations (mean [standard deviation] 3.4 [6.6] vs 2.7 [8.6] per patient, P = 0.01), but no significant difference in HF rehospitalizations (0.9 [2.3] vs 0.9 [4.5] per patient, P = 0.74). Patients with COPD had more annual physician visits, multidisciplinary clinic visits, and supportive care (all P < 0.01), as well as greater annual direct health care costs in Canadian dollars (at 5 years: $91,888 [$109,319] vs $76,823 [$116,218]) than those without COPD, primarily driven by rehospitalizations.

Conclusions

Among patients discharged alive after hospitalization for HF, COPD is common and is associated with higher all-cause mortality and all-cause rehospitalizations, greater health care use, and higher direct health care costs. Interventions to reduce the health care burden in HF should include broad approaches that address important comorbidities.