The effect of emphysema on readmission and survival among smokers with heart failure

Autor: Udo Hoffmann, Michael T. Lu, Richard A.P. Takx, Puja Kohli, Travis R. Hallett, Orla Hennessy, Florian J. Fintelmann, Pedro V. Staziaki, R. S. Harris, Bartolome R. Celli, Marc J. Semigran, Sumbal Janjua, Daniel Addison, Tomas G. Neilan
Rok vydání: 2018
Předmět:
Male
Pulmonology
lcsh:Medicine
030204 cardiovascular system & hematology
Vascular Medicine
Diagnostic Radiology
Pulmonary Disease
Chronic Obstructive
0302 clinical medicine
Endocrinology
Risk Factors
Medicine and Health Sciences
Coronary Heart Disease
Registries
lcsh:Science
Tomography
Aged
80 and over
COPD
Multidisciplinary
Ejection fraction
medicine.diagnostic_test
Radiology and Imaging
Smoking
Middle Aged
3. Good health
Survival Rate
Cardiology
Female
Research Article
Spirometry
medicine.medical_specialty
Imaging Techniques
Endocrine Disorders
Chronic Obstructive Pulmonary Disease
Neuroimaging
Research and Analysis Methods
Patient Readmission
Disease-Free Survival
03 medical and health sciences
Diagnostic Medicine
Internal medicine
medicine
Diabetes Mellitus
Humans
Risk factor
Survival rate
Aged
Retrospective Studies
Heart Failure
Emphysema
business.industry
lcsh:R
Biology and Life Sciences
Retrospective cohort study
medicine.disease
respiratory tract diseases
Computed Axial Tomography
030228 respiratory system
Heart failure
Metabolic Disorders
lcsh:Q
business
Tomography
X-Ray Computed
Neuroscience
Ejection Fraction
Zdroj: PLoS ONE
PLoS ONE, Vol 13, Iss 7, p e0201376 (2018)
ISSN: 1932-6203
Popis: Heart Failure (HF) and chronic obstructive pulmonary disease (COPD) are morbid diseases that often coexist. In patients with coexisting disease, COPD is an independent risk factor for readmission and mortality. However, spirometry is often inaccurate in those with active heart failure. Therefore, we investigated the association between the presence of emphysema on computed tomography (CT) and readmission rates in smokers admitted with heart failure (HF). The cohort included a consecutive group of smokers discharged with HF from a tertiary center between January 1, 2014 and April 1, 2014 who also had a CT of the chest for dyspnea. The primary endpoint was any readmission for HF before April 1, 2016; secondary endpoints were 30-day readmission for HF, length of stay and all-cause mortality. Over the study period, there were 225 inpatient smokers with HF who had a concurrent chest CT (155 [69%] males, age 69±11 years, ejection fraction [EF] 46±18%, 107 [48%] LVEF of < 50%). Emphysema on CT was present in 103 (46%) and these were older, had a lower BMI, more pack-years, less diabetes and an increased afterload. During a follow-up of 2.1 years, there were 110 (49%) HF readmissions and 55 (24%) deaths. When separated by emphysema on CT, any readmission, 30-day readmission, length of stay and mortality were higher among HF patients with emphysema. In multivariable regression, emphysema by CT was associated with a two-fold higher (adjusted HR 2.11, 95% CI 1.41-3.15, p < 0.001) risk of readmission and a trend toward increased mortality (adjusted HR 1.70 95% CI 0.86-3.34, p = 0.12). In conclusion, emphysema by CT is a frequent finding in smokers hospitalized with HF and is associated with adverse outcomes in HF. This under recognized group of patients with both emphysema and heart failure may benefit from improved recognition and characterization of their co-morbid disease processes and optimization of therapies for their lung disease.
Databáze: OpenAIRE
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