ERS Respiratory Channel

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Abstract

Introduction: COPD patients suffer recurrent admissions, which are difficult to prevent. We explored whether underdiagnosis or undertreatment of heart disease was related to hospital admissions.

Methods: 115 patients admitted with COPD exacerbation (ECOPD) were categorised based on chart-recorded diagnoses (?clinical diagnoses?): Known heart disease (significant heart failure [HF] or coronary artery disease [CAD]); or None. Known patients were Treated optimally or Undertreated, based on NICE/ESC guidelines. 57 patients were randomly selected for structured cardiac assessment (SCA), including echocardiogram and CT coronary artery calcium score, and categorised likewise. Relationships with admission in the past year were tested (Chi-square, 2-sided).

Results:

By clinical diagnoses: 17% of 115 had CAD, 7% HF. 36% were undertreated.

After SCA: 35% of 57 were newly diagnosed with CAD, 12% with HF. Heart disease was present in 65%, 62% were undertreated.

		n	Any admission %		ECOPD admission %
Clinical diagnoses	None	90	53	p=0.54	37	p=0.17
	Known Treated	16	44		31
	Undertreated	9	67		67
SCA	None	35	35	p=0.08	25	p=0.14
	Known Treated	71	71		29
	Undertreated	61	61		52

After SCA, patients with heart disease were almost twice as likely to have been admitted for any cause in the past year. Patients with undertreated heart disease were twice as likely to have been admitted for ECOPD. Small numbers limit statistical power.

Discussion: Underdiagnosis and undertreatment were rife. Readmission is commoner in those with heart disease and, intriguingly, ECOPD admission rates may be higher in those who are undertreated. A rigorous assessment for heart disease may help direct interventions to tackle recurrent admissions.

Abstract

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