Impact of chronic obstructive pulmonary disease on readmission after hospitalization for acute heart failure: A nationally representative US cohort study

Background: Patients hospitalized for heart failure (HF) are at high risk of readmission. Chronic obstructive pulmonary disease (COPD) is one of the most prevalent comorbidities in this population. However, few data and only small studies describe the impact of COPD on the risk of readmission. Methods and results: Hospitalizations for HF were identified in the 2012 National Readmissions Database. We compared clinical characteristics and the risk of all-cause, cardiovascular (CV) and respiratory-related readmission for patients with and without COPD. We included 225,160 patients hospitalized for HF among whom 54,953 had comorbid COPD. Patients with COPD were younger (median age 76 years COPD versus 77 years without COPD; p < 0.001), had a higher burden of comorbidity and were more frequently male (53% versus 49%, p < 0.001). Thirty-day all-cause readmission risk was two-fold greater in patients with COPD compared to those without COPD (adjusted HR 2.02, 95% CI 1.97-2.08). Most readmissions were attributed to a CV cause, though fewer patients with COPD had a CV admission (49% versus 51% without COPD). COPD was independently associated with significantly more frequent unplanned respiratory-related readmission (adjusted HR 2.90, 95% CI 2.68-3.15) as well as CV readmission risk (adjusted HR 1.92, 95% CI 1.85-1.99). Conclusions: In patients hospitalized for HF, most readmissions are due to a CV cause. However, patients with comorbid COPD are at a significantly elevated risk of respiratory in addition to CV-related readmission. These data stress the importance of a multidisciplinary management approach, including optimization of non-CV conditions, in order to reduce readmissions post index HF hospitalization. (C) 2019 Elsevier B.V. All rights reserved.