Pulmonology Xagena

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COPD patients with pneumonia : a prior cardiovascular disease increases long-term mortality

There is controversy regarding the impact of chronic obstructive pulmonary disease ( COPD ) in clinical outcomes in elderly patients with pneumonia.
Comorbidities such as cardiovascular disease have been reported to play an important role in patients with acute exacerbations of COPD.
However, limited data are available regarding the impact of cardiovascular disease in elderly COPD patients who require hospitalisation for pneumonia.

Researchers have examined a cohort of subjects with pneumonia and pre-existing COPD. Prior cardiovascular disease was defined as history of myocardial infarction, congestive heart failure, cardiac arrhythmia, unstable angina or stroke.

Outcomes examined included 30-day, 90-day, 6-month and 1-year mortality.

Investigators included 17140 elderly COPD patients who were hospitalised for pneumonia.

Prior cardiovascular disease was present in 10240 ( 59.7% ) patients. Prior cardiovascular disease was independently associated with 90-day mortality ( 21.3% versus 19.4%; hazard ratio, HR=1.29 ), 6-month mortality ( 29.0% versus 26.1%; HR=1.28 ) and 12-month mortality ( 39.2% versus 34.5%; HR=1.33 ) when compared to no prior cardiovascular disease.

The temporal differential effect between groups increases from 1.0% at 30 days to 4.7% at 1 year.

In conclusion, a prior cardiovascular disease is associated with increased long-term mortality in elderly COPD patients with pneumonia. Differences in mortality rates increased over time. ( Xagena )

Sibila O et al, ERJ 2014 ; 43: 36-42