@article{Gulea:2022:10.1136/bmjopen-2021-059122,
author = {Gulea, C and Zakeri, R and Kallis, C and Quint, J},
doi = {10.1136/bmjopen-2021-059122},
journal = {BMJ Open},
title = {Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis},
url = {http://dx.doi.org/10.1136/bmjopen-2021-059122},
volume = {12},
year = {2022}
}

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TY  - JOUR
AB  - 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.
AU  - Gulea,C
AU  - Zakeri,R
AU  - Kallis,C
AU  - Quint,J
DO  - 10.1136/bmjopen-2021-059122
PY  - 2022///
SN  - 2044-6055
TI  - Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis
T2  - BMJ Open
UR  - http://dx.doi.org/10.1136/bmjopen-2021-059122
UR  - http://hdl.handle.net/10044/1/97547
VL  - 12
ER  - 

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