Influence of Comorbid Risk Factors and Prehospital Medications on Patients With Heart Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

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SESSION TITLE: Advances in Cardiac Disease SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 26, 2015 at 04:30 PM - 05:30 PM PURPOSE: Heart failure (HF) often worsens clinical outcomes in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) despite appropriate in-hospital therapy. METHODS: This is a 5-year retrospective study on patients admitted with AECOPD. Patients were divided in left (LHF) vs right (RHF) vs biventricular HF (BiHF). Pre-morbid conditions such as obstructive sleep apnea (OSA), coronary artery disease (CAD) and use of pre-hospital angiotensin-converting-enzyme inhibitor (ACE-i)/angiotensin-receptor blocker (ARB), beta-blockers (BB) and 3-hydroxy-3-methylglutaryl CoA reductase inhibitors (statins) was analyzed. Outcomes included need and duration of non-invasive ventilation (NIV) and mechanical ventilation (MV), intensive care unit (ICU) length of stay (LOS) and total LOS (days). The data was assessed using chi-square test and Fisher's exact test. Two-tailed p-value <0.05 was considered statistically significant. RESULTS: A total of 735 patients met our inclusion criteria and were included in this study. HF was noted in 419 (57.0%) patients - LHF 165 (39.4%), RHF 154 (36.8%) and BiHF 100 (23.8%) (Mean left ventricular ejection fraction 52.4±15%). OSA increased ICU LOS in BiHF (5.1±0.4 vs 1.6±0.6, p=0.003), LHF (4.2±0.3 vs 2.6±0.5, p=0.03), RHF (4.3±0.6 vs 2.6±0.3, p=0.007) and no HF (5.6±0.6 vs 3.2±0.2, p<0.0001). MV days were increased in CAD+BiHF (9.5±1.5 vs 5.4±0.6, p=0.005), CAD+LHF (4.6±0.6 vs 2.6±0.5, p=0.01), OSA+LHF (4.4±0.5 vs 0.9±0.5, p=0.004) and OSA+no HF (6.2±1.0 vs 2.8±0.3, p<0.0001). Pre-hospital BB use decreased (a) MV in LHF (17.5% vs 5.6%); (b) MV days in BiHF (6.9±0.6 vs 2.0±0.9) and no HF (4.9±0.7 vs 2.7±0.3); (c) ICU LOS in LHF (5.3±0.5 vs 3.3±0.3), BiHF (5.2±0.4 vs 2.1±0.6) and no HF (5.1±0.5 vs 3.2±0.3); and (d) total LOS in LHF (7.1±0.7 vs 5.3±0.4) and no HF (6.0±0.5 vs. 4.8±0.2) (all p<0.05). In LHF, statins reduced NIV use (41.9% vs 26.6%, p=0.03), MV days (4.6±0.6 vs 2.5±0.5, p=0.01) and ICU LOS (4.4±0.4 vs 3.3±0.4, p=0.04). ACE-i/ARB reduced MV days and ICU LOS for BiHF (7.7±0.8 vs 3.4±0.7; 6.0±0.5 vs 3.0±0.4) and RHF (3.3±0.6 vs 1.4±0.5; 3.6±0.4 vs 2.5±0.3) (all p<0.05). CONCLUSIONS: In this hypothesis-generating study on patients with AECOPD, pre-hospital cardiac medications predict better outcomes in concomitant HF. CAD with coexisting LHF/BiHF portends a worse prognosis while OSA is associated with worse outcomes independent of HF. CLINICAL IMPLICATIONS: Pre-hospital factors influence outcomes in AECOPD patients with HF and merit further study in prospective trials. DISCLOSURE: The following authors have nothing to disclose: Saraschandra Vallabhajosyula, Pranathi Sundaragiri, Anas Ahmed, Hamza Rayes, Toufik Mahfood Haddad, Haitam Buaisha, Anila Khan, Gene Pershwitz, Muhammad Sarfraz Nawaz, Dustin McCann, Christopher Wichman, Mark Holmberg, Lee Morrow No Product/Research Disclosure Information