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The Impact of COPD on Management and Outcomes of Patients Hospitalized with Acute Myocardial Infarction – A Ten-Year Retrospective Observational Study
Chest, 01/06/2012
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Clinical Article
Stefan MS et al. – The results suggest that the gap in medical care between patients with and without COPD hospitalized with acute myocardial infarction (AMI) narrowed substantially between 1997 and 2007. Patients with COPD, however, remain less aggressively treated and are at increased risk for hospital adverse outcomes than patients without COPD in the setting of AMI. Careful consideration is necessary to ensure that these high risk complex patients are not denied the benefits of effective cardiac therapies.
Methods- The study population consisted of patients hospitalized with AMI at all greater Worcester (MA) medical centers between 1997 and 2007.
- Of the 6,290 patients hospitalized with AMI, 17% had a history of COPD.
- Patients with COPD were less likely to be treated with beta–blockers, lipid lowering therapy, and have undergone interventional procedures during their index hospitalization that patients without COPD.
- Patients with COPD were at higher risk for dying during hospitalization (13.5% vs. 10.1%), and at 30 days after discharge (18.7% vs. 13.2%) and their outcomes did not improve during the decade long period under study.
- After multivariable adjustment, the adverse effects of COPD remained on both in–hospital (OR: 1.25, 95% CI: 0.99–1.50) and 30–day all–cause mortality (OR: 1.31, 95% CI: 1.10–1.58).
- The use of evidence–based therapies for all patients with AMI increased between 1997 and 2007, with a particularly marked increase for patients with COPD.
Mihaela S. Stefan (01/15/2012) comments:
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. There is considerable research and clinical interest in the extrapulmonary manifestations and comorbid conditions associated with COPD.
COPD is a systemic disease and it is now understood to involve chronic inflammation which affects many organ systems. Ischemic heart disease is common in COPD and is a significant cause of mortality and morbidity.
IN our study, we found that patients with AMI and COPD are treated less aggressively than patients without COPD and their outcomes are significantly worse. Furthermore, over the last 10 years although there was an increase in the use of recommended cardiac interventions in patients with AMI and COPD, the gap still persist and mortality of patients with AMI and COPD remained unchanged.
