Abstract
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.
Highlights
Heart failure and chronic obstructive pulmonary disease (COPD) are both global epidemics that incur significant morbidity and mortality [1]
In this study we aimed to add to this limited data and hypothesized that emphysema by computed tomography (CT) is associated with an increase in hospital readmission and mortality among patients with complex Heart Failure (HF). This was a historical-cohort single-center study. This investigation conforms with the principles outlined in the Declaration of Helsinki and the research protocol was approved by the Partners Human Research Committee (PHRC), the Institutional Review Board (IRB) of Partners Healthcare, which waived the need for informed consent
Patients without a contemporary CT scan (91 subjects) were excluded leaving a final study cohort of 225 smokers with adjudicated HF discharged from an academic center over a 3-month period with a recent chest CT
Summary
Heart failure and chronic obstructive pulmonary disease (COPD) are both global epidemics that incur significant morbidity and mortality [1]. These systemic disorders often coexist with overlapping clinical symptoms and pathophysiologic processes [2]. Few have studied the prognostic implications of comorbid illness with HF and COPD, but these studies have shown that the presence of COPD is an independent predictor of death and HF hospitalization [2]. Readmission after a HF hospitalization is still high [7]. Reducing heart failure hospital readmissions is paramount for improved patient care and health care costs
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