Guideline-directed medical therapy and mortality in heart failure patients hospitalized for COPD exacerbation.

RATIONALE: Real-world effectiveness of cardiovascular and LABA/LAMA treatment in patients with heart failure (HF) during hospitalized exacerbation of COPD (ECOPD) is limited.

OBJECTIVES

To investigate associations of guideline-directed medical therapy (GDMT) during hospitalization with in-hospital and post-discharge all-cause mortality and readmission risk.

METHODS

HF patients aged ≥18 years hospitalized for ECOPD were included in this Belgian nationwide observational cohort between 2017-2022. HF GDMT was defined as use of at least beta-blockers in combination with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors following 2016 ESC guidelines, whereas COPD GDMT was defined as use of at least LABA+LAMA following 2017 GOLD report. Multivariable adjusted logistic regression and time-to-event analyses were used to investigate the associations.

MAIN

RESULTS

Among 14,582 patients (mean age 76.8 years, 40.7% females), GDMT was dispensed for HF only (20.4%), COPD only (23.6%) or both HF and COPD (11.9%). During hospitalization, 14.1% (2,058/14,582) died: 18.1% (no GDMT), 11.1% (HF GDMT), 11.0% (COPD GDMT) and 7.9% (both GDMT), respectively. HF GDMT was significantly associated with a 38% lower in-hospital mortality odds (aOR 0.62, 95%CI 0.55-0.70), while COPD GDMT was independently associated with a 40% lower odds (aOR 0.60, 95%CI 0.53-0.67). HF GDMT, alone (aHR 0.83, 95%CI 0.77-0.88) or combined with COPD GDMT (aHR 0.82, 95%CI 0.75-0.89), was associated with a significantly lower post-discharge mortality risk, whereas no significant associations between GDMT and readmission were observed.

CONCLUSIONS

These results highlight the importance of HF GDMT, alongside optimised COPD management during hospitalization, to reduce in-hospital and post-discharge mortality risk.