Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department.

Mariaenrica Tinè,Manuel G Cosio,Marina Saetta,Davide Biondini,Simonetta Baraldo,Elisabetta Balestro,Elisabetta Cocconcelli,Graziella Turato,Alvise Casara,Umberto Semenzato,Erica Bazzan

doi:10.3390/jcm9082644

Abstract

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.

Highlights

Chronic obstructive pulmonary disease (COPD), whose main risk factors are alpha1 antitrypsin deficiency and cigarette smoking, is characterized by an inflammatory reaction to the inciting agent, such as cigarette smoking, that, by destroying lung airways and parenchyma, progressively diminishes the ventilatory capacity [1,2].About 75% of patients with Chronic Obstructive Pulmonary Disease (COPD) over 10 years [3] might suffer from acute exacerbations of their disease (AECOPD), characterized by symptomatic deterioration with increased dyspnoea, cough and sputum beyond the day to day variation
The diagnosis assigned by the emergency department (ED) physicians for these patients who presented with acute severe exacerbation of respiratory symptoms was obtained from the patients chart and read as: (1) respiratory failure secondary to acute exacerbations of COPD (AECOPD), which included patients diagnosed in the ED of acute exacerbation due to COPD with no other adjunctive causes; (2) respiratory failure secondary to AECOPD and HF, which included patients diagnosed in the ED of acute exacerbation due to COPD and concomitant heart failure; (3) respiratory failure secondary to other diagnosis (OD) which included patients with acute exacerbation of respiratory symptoms thought to be due to other diagnosis than AECOPD or AECOPD and HF
The laboratory data at discharge from the respiratory ward (RW) showed no differences in the white blood cells count except for the lymphocytes number, which was significantly lower in AECOPD and HF than in AECOPD and OD (p = 0.01) and tended to be lower than in AECOPD (p = 0.07)

Summary

Introduction

About 75% of patients with COPD over 10 years [3] might suffer from acute exacerbations of their disease (AECOPD), characterized by symptomatic deterioration with increased dyspnoea, cough and sputum beyond the day to day variation. These episodes might lead to a change in the medical treatment in moderate AECOPD or to emergency department (ED) visits and hospitalization in severe AECOPD [1]. 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

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