Heart failure in patients with COPD exacerbations: Looking below the tip of the iceberg
Heart failure in patients with COPD exacerbations: Looking below the tip of the iceberg
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DOI：
10.1016/j.rmed.2022.106800
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发表时间：
2022-03-17
影响因子：
4.3
通讯作者：
Steer, John
中科院分区：
文献类型：
--
作者：
Hesse, Kerrick;Bourke, Stephen;Steer, John
背景资料：因慢性阻塞性肺疾病（ECOPD）急性加重而住院的患者发生心血管事件的风险增加。慢性阻塞性肺疾病患者的心力衰竭往往诊断不足，治疗不足;更好的护理可以改善预后。我们的目的是捕捉当代的调查和管理的心力衰竭（HF）住院患者ECOPD.Methods：在英国的两家医院，2017年和2020年之间入院的ECOPD患者进行了回顾性研究。使用方差分析和卡方检验比较已知、新诊断和无HF之间的基线特征。通过Kaplan-Meier分析和考克斯比例风险回归评估HF对死亡率的影响。NT-proBNP诊断HF的敏感性和特异性在公认的thresholds.Results：入院时，94/476（19.7%）患者已知HF。在其余患者中，89/382（23.3%）在入院后100天内接受了调查，其中38例确认为HF。在33例射血分数降低的心力衰竭（HFrEF）患者中，18例（54.5%）接受了ACE抑制剂和B受体阻滞剂治疗。77/132例HF患者（58.3%）和108/344例非HF患者（31.4%）在随访期间（中位数11.7个月）死亡（校正HR 2.03，95% CI 1.46-2.82，p < 0.001）。当NT-proBNP浓度≥ 400 pg/mL时，其NPV和PPV对诊断HF的阳性率分别为77.8%和82.8%。在合并HF的患者中，治疗不足是常见的，1年死亡率超过50%。NT-proBNP可能有助于识别需要心血管功能成像的患者。目前迫切需要研究如何提高COPD住院患者HF的诊断和治疗水平。
Background: Patients surviving hospitalization for exacerbations of chronic obstructive pulmonary disease (ECOPD) are at heightened risk of cardiovascular events. Heart failure is often underdiagnosed and undertreated in COPD; better care could improve outcome. We aimed to capture contemporary investigation and management of heart failure (HF) in patients hospitalized with ECOPD.Methods: In two UK hospitals, patients admitted with ECOPD between 2017 and 2020 were retrospectively identified. Baseline characteristics between known, newly diagnosed and no HF were compared using analysis of variance and chi-squared test. Impact of HF on mortality was assessed by Kaplan-Meier analysis and Cox proportional-hazards regression. Sensitivity and specificity of NT-proBNP for diagnosing HF at recognized thresholds were reported.Results: On admission, 94/476 (19.7%) patients had known HF. Among remaining patients, 89/382 (23.3%) were investigated within 100 days of admission, confirming HF in 38. Of 33 patients with heart failure with reduced ejection fraction (HFrEF), 18 (54.5%) were prescribed ACE-inhibitor and B-blocker. 77/132 patients (58.3%) with HF and 108/344 patients (31.4%) without HF died (adjusted HR 2.03, 95% CI 1.46-2.82, p < 0.001) during follow up (median 11.7 months). At >= 400 pg/mL, NPV and PPV of NT-proBNP for the diagnosis of HF were 77.8% and 82.8%.Conclusions: A new diagnosis of HF was made in over 40% investigated. In patients with coexistent HF, under-treatment was common and 1-year mortality exceeded 50%. NT-proBNP may help identify patients who need cardiovascular functional imaging. Research to improve HF diagnosis and treatment in hospitalized ECOPD is urgently needed.