Chest
Original ResearchCardiovascular DiseaseThe Impact of COPD on Management and Outcomes of Patients Hospitalized With Acute Myocardial Infarction: A 10-Year Retrospective Observational Study
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
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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].
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