Interplay between acute heart failure and COPD in patients hospitalized for dysponea: prognostic insights from the PARADISE cohort.

INTRODUCTION

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are leading causes of acute dyspnoea in the emergency department (ED) and frequently coexist. However, their combined impact on short- and long-term outcomes in the acute setting remains insufficiently characterized.

METHODS

We conducted a monocentric observational study based on the PARADISE cohort, including patients admitted to the ED for acute dyspnoea between 2010 and 2019. Patients with a primary diagnosis of HF or COPD were included and stratified according to the presence of the alternate condition. The primary outcomes were in-hospital and post-discharge all-cause mortality, assessed using multivariable regression models.

RESULTS

Among 5131 patients, 3543 had a primary diagnosis of HF and 1588 of COPD. Concomitant disease was present in approximately 20% of patients in both groups.In the primary HF cohort, patients with COPD had lower in-hospital mortality compared with those without COPD (8.5% vs. 11.7%, P = .014), but similar overall mortality (69.3% vs. 68.9%). After adjustment, COPD remained associated with lower in-hospital mortality (OR 0.74; 95% CI 0.55-0.99; P = .050) and with a modest increase in long-term mortality (HR 1.22; 95% CI 1.09-1.36; P < .001).In the primary COPD cohort, patients with HF had higher in-hospital mortality (7.4% vs. 3.4%, P = .001) and markedly higher long-term mortality (68.7% vs. 48.7%, P < .001). After adjustment, HF was not significantly associated with in-hospital mortality (OR 1.54; 95% CI 0.87-2.65; P = .13), but remained strongly associated with increased long-term mortality (HR 1.48; 95% CI 1.25-1.76; P < .001).

CONCLUSION

HF and COPD frequently coexist and are both associated with an increased long-term mortality risk, with a greater prognostic impact of HF in patients with COPD. These findings highlight the importance of systematic identification and optimized management of both conditions in this high-risk population.