Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department
Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department
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DOI：
10.3390/jcm9082644
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发表时间：
2020-08-01
影响因子：
3.9
通讯作者：
Saetta, Marina
中科院分区：
文献类型：
--
作者：
Tine, Mariaenrica;Bazzan, Erica;Saetta, Marina
背景：大约20%的稳定期慢性阻塞性肺疾病（COPD）患者可能患有心力衰竭（HF）。HF对急诊科（艾德）就诊的COPD急性加重（AECOPD）的影响尚未明确。目的：评估（1）因AECOPD而到艾德就诊的患者的HF发生率;（2）艾德和呼吸病房（RW）诊断之间的一致性;（3）出院后死亡风险的相关因素。研究方法：回顾性病历审查了119例因呼吸道症状急性加重而就诊于艾德，然后入住RW的COPD患者，获得了AECOPD、AECOPD和HF以及AECOPD和OD（其他诊断）的最终诊断。然后比较艾德和RW的诊断。研究了影响随访生存率的因素。结果如下：在RW，40.3%的病例被诊断为AECOPD，40.3%的病例被诊断为AECOPD和HF，19.4%的病例被诊断为AECOPD和OD，艾德诊断与RW的诊断分别为67%、23%和57%。在RW，GOLD 1中60%的患者患有HF，其中43%在艾德被诊断，而GOLD 4中40%的患者患有在ED时从未被诊断的HF。缺乏COPD护理计划、HF和AECOPD早期再入院与死亡率相关。结论：HF在因重度AECOPD就诊于艾德的所有GOLD分期患者中高度流行且难以诊断，并且沿着缺乏COPD护理计划，导致死亡风险高。
Background: Some 20% of patients with stable Chronic Obstructive Pulmonary Disease (COPD) might have heart failure (HF). HF contribution to acute exacerbations of COPD (AECOPD) presenting to the emergency department (ED) is not well established. Aims: To assess (1) the HF incidence in patients presenting to the ED with AECOPD; (2) the concordance between ED and respiratory ward (RW) diagnosis; (3) the factors associated with risk of death after hospital discharge. Methods: Retrospective chart review of 119 COPD patients presenting to ED for acute exacerbation of respiratory symptoms and then admitted to RW where a final diagnosis of AECOPD, AECOPD and HF and AECOPD and OD (other diagnosis), was obtained. ED and RW diagnosis were then compared. Factors affecting survival at follow-up were investigated. Results: At RW, 40.3% of cases were diagnosed of AECOPD, 40.3% of AECOPD and HF and 19.4% of AECOPD and OD, with ED diagnosis coinciding with RW's in 67%, 23%, and 57% of cases respectively. At RW, 60% of patients in GOLD1 had HF, of which 43% were diagnosed at ED, while 40% in GOLD4 had HF that was never diagnosed at ED. Lack of inclusion in a COPD care program, HF, and early readmission for AECOPD were associated with mortality. Conclusions: HF is highly prevalent and difficult to diagnose in patients in all GOLD stages presenting to the ED with severe AECOPD, and along with lack of inclusion in a COPD care program, confers a high risk for mortality.