Clinical and economic impact of concomitant heart failure in patients with exacerbated COPD

Co-occurrence of chronic obstructive pulmonary disease (COPD) and heart failure (HF) is frequent, worsens prognosis and increases healthcare resources use and costs. This research aims to quantify the impacts of HF as a concomitant diagnosis with COPD.

Retrospective, observational study of consecutive patients aged 40 years or older who visited the emergency department (ED) during 2018 for COPD exacerbation. One-year clinical outcomes, resource utilization and costs were compared between those with and without HF, using the Clinical Outcomes, HEalthcare REsource utilizatioN, and relaTed costs (COHERENT) model.

Among 2384 COPD patients, mean age was 75.7 years, 40.1 % women. Of these 35.1 % had concomitant diagnosis of HF. Patients with COPD and HF exhibited higher 1-year rates of mortality (31.2 % vs 19.2 %, p < 0.001), hospitalization (95.6 % vs 78.9 %, p < 0.001), readmission and return to ED. Adjusted for age, sex and comorbidity, HF was an independent predictor of mortality (HR, 1.25; 95 %CI, 1.03-1.50; p = 0.02). Also, HF coexistence was independently associated with a 42 % excess in mean 1-year healthcare cost (ratio of means, 1.42; 95 %CI, 1.24-1.63; p < 0.001), adjusted for age and comorbidities.

The concomitant diagnosis of HF in patients with COPD exacerbation is associated with increased 1-year risk of all outcomes, increased use of healthcare resources and almost a doubling in total costs. Specific multidisciplinary strategies targeting these patients may be needed to improve their outcomes and reduce costs.