Chest
Volume 141, Issue 6, June 2012, Pages 1441-1448
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Original Research
Cardiovascular Disease
The Impact of COPD on Management and Outcomes of Patients Hospitalized With Acute Myocardial Infarction: A 10-Year Retrospective Observational Study

https://doi.org/10.1378/chest.11-2032Get rights and content

Background

There are limited data describing contemporary trends in the management and outcomes of patients with COPD who develop acute myocardial infarction (AMI).

Methods

The study population consisted of patients hospitalized with AMI at all greater Worcester, Massachusetts, medical centers between 1997 and 2007.

Results

Of the 6,290 patients hospitalized with AMI, 17% had a history of COPD. Patients with COPD were less likely to be treated with β-blockers or lipid-lowering therapy or to have undergone interventional procedures during their index hospitalization than 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.

Conclusions

Our results suggest that the gap in medical care between patients with and without COPD hospitalized with 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.

Section snippets

Materials and Methods

The Worcester (Massachusetts) Heart Attack Study is an ongoing population-based investigation examining long-term trends in the incidence and death rates of greater Worcester (2000 census: 478,000) residents hospitalized with AMI at all metropolitan Worcester medical centers. The methods used in this study have been previously described in detail.9, 10, 11 Data have been collected on a biennial basis since 1975; a total of 6,290 patients hospitalized with independently validated AMI during the

Study Population Characteristics

Of the 6,290 patients hospitalized with AMI within the 10-year period of the study, 17% had COPD. Overall, the average age of this population was 71 years, and 56% were men. Compared with patients without COPD, patients with COPD were, on average, 4 years older and more likely to be current smokers and to have had angina, heart failure (HF), hypertension, diabetes, renal disease, and stroke previously diagnosed. Patients with COPD were more likely to have presented with a non-ST-segment

Discussion

The results of this large observational study among residents of central Massachusetts hospitalized with AMI between 1997 and 2007 demonstrate significant differences among patients with and without COPD with regard to clinical presentation, treatments received, and hospital outcomes. Patients with COPD were more likely to have an atypical clinical presentation, were less likely to have been prescribed evidence-based cardiac therapies and interventional procedures during their hospitalization

Conclusions

In summary, patients with AMI and COPD were less likely to receive evidence-based therapies during hospitalization, and they had a higher risk of dying during hospitalization and at 30 days after discharge. Although the use of therapies recommended per current guidelines increased in all patients hospitalized with AMI during the 10 years under study, and the gap in care quality between patients with and without COPD closed substantially, differences in treatment persist, and the outcomes of

Acknowledgments

Author contributions: Dr Stefan: contributed to study conception and design, data analysis and interpretation, and drafting the manuscript for important intellectual content.

Dr Bannuru: contributed to study conception and design, data analysis and interpretation, and drafting the manuscript for important intellectual content.

Ms Lessard: contributed to data analysis and interpretation and drafting and revising the manuscript.

Dr Gore: contributed to drafting the manuscript for important

References (23)

  • National Center for Health StatisticsNational Health and Nutrition Examination Survey data

    US Centers for Disease Control website

  • Cited by (0)

    Funding/Support: This study was funded by the National Institutes of Health [Grant RO1 HL35434]. Dr Stefan is supported by the National Cancer Institute [Grant KM1 CA156726]. Dr Bannuru is supported by the Agency for Healthcare Research and Quality [Grant T32 HS000060]. Drs Bannuru and Stefan are supported by the National Center for Research Resources [Grant UL1 RR025752].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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