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Lin MJ, Zou SB, Zhu BX. Effect of dapagliflozin on uric acid in patients with chronic heart failure and hyperuricemia. World J Clin Cases 2024; 12:3468-3475. [DOI: 10.12998/wjcc.v12.i18.3468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Patients with chronic heart failure (CHF) frequently develop hyperuricemia, an elevated serum uric acid level, associated with adverse outcomes. Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, demonstrates reduction in cardiovascular mortality and hospitalization in patients with CHF and ejection fraction (HFrEF), irrespective of diabetes. However, dapagliflozin’s effect on the uric acid levels in patients with CHF and hyperuricemia remain unclear.
AIM To investigate the effects of dapagliflozin on uric acid levels in CHF patients with hyperuricemia.
METHODS We conducted a randomized, double-blind, placebo-controlled trial in 200 patients with CHF and hyperuricemia, with HFrEF and serum uric acid levels ≥ 7 mg/dL (≥ 416 μmol/L). The participants were randomly assigned to receive a daily dose of 10 mg dapagliflozin or placebo for 24 months. The primary endpoint was the change in serum uric acid level from baseline to 24 months. Secondary endpoints included changes in left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and quality of life (QoL) scores, as well as the incidence of cardiovascular death and hospitalization for heart failure.
RESULTS At 24 months, dapagliflozin significantly reduced serum uric acid levels by 1.2 mg/dL (71 μmol/L) compared with placebo (95%CI: -1.5 to -0.9; P < 0.001). Dapagliflozin also significantly improved LVEF by 3.5% (95%CI: 2.1-4.9; P < 0.001), NT-proBNP by 25% (95%CI: 18-32; P < 0.001), and QoL scores by 10 points (95%CI: 7-13; P < 0.001) and reduced the risk of cardiovascular death and hospitalization for heart failure by 35% (95%CI: 15–50; P = 0.002) compared with the placebo. Adverse events were similar between the two groups, except for a higher rate of genital infections in the dapagliflozin group (10% vs 2%, P = 0.01).
CONCLUSION Dapagliflozin significantly lowered serum uric acid levels and improved the clinical outcomes in patients with CHF and hyperuricemia. Therefore, dapagliflozin may be a useful therapeutic option for this high-risk population.
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Affiliation(s)
- Meng-Jiao Lin
- Three departments of cardiovascular medicine, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Shu-Bin Zou
- Three departments of cardiovascular medicine, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Bai-Xiang Zhu
- Three departments of cardiovascular medicine, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
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Choi HG, Kwon MJ, Kim JH, Kim JH, Kim Y, Kim SY. Association Between COPD and Hearing Loss. Laryngoscope 2024. [PMID: 38828668 DOI: 10.1002/lary.31548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE The goal of the present study was to estimate the risk of hearing impairment in patients with COPD using huge nationwide population. METHODS A retrospective case-control study was performed using the National Health Insurance Database in South Korea from 2002 through 2019. Totally 614,370 COPD patients and matched 2,170,504 control participants were selected at a 1:4 ratio. Hearing impairment was defined based on the registered data in the Ministry of Health and Welfare of Korea with six levels of severity of hearing impairment. The propensity score was calculated, and overlap-weighted multinomial logistic regression was used to calculate the odds ratios of COPD for hearing impairment. RESULTS A total of 2.67% of COPD patients and 1.9% of control participants had hearing impairment. The COPD patients indicated 1.10-1.21 times higher odds for hearing impairment according to the severity of hearing impairment than the control group. In accordance with age and sex, the younger age group (<65 years old) and female group demonstrated higher odds for hearing impairment related to the presence of COPD. The high odds for hearing impairment in patients with COPD was consistent in all other subgroups, except for the underweight group. CONCLUSIONS COPD was associated with an increased risk of hearing impairment in the general population in Korea. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Hyo Geun Choi
- Mdanalytics, Seoul, Republic of Korea
- Suseoseoulent Clinic, Seoul, Republic of Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Joo-Hee Kim
- Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Yoonjoong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - So Young Kim
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Yan T, Song S, Sun W, Ge Y. HAPLN1 knockdown inhibits heart failure development via activating the PKA signaling pathway. BMC Cardiovasc Disord 2024; 24:197. [PMID: 38580957 PMCID: PMC10996236 DOI: 10.1186/s12872-024-03861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/26/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a heterogeneous syndrome that affects millions worldwide, resulting in substantial health and economic burdens. However, the molecular mechanism of HF pathogenesis remains unclear. METHODS HF-related key genes were screened by a bioinformatics approach.The impacts of HAPLN1 knockdown on Angiotensin II (Ang II)-induced AC16 cells were assessed through a series of cell function experiments. Enzyme-linked immunosorbent assay (ELISA) was used to measure levels of oxidative stress and apoptosis-related factors. The HF rat model was induced by subcutaneous injection isoprenaline and histopathologic changes in the cardiac tissue were assessed by hematoxylin and eosin (HE) staining and echocardiographic index. Downstream pathways regulated by HAPLN1 was predicted through bioinformatics and then confirmed in vivo and in vitro by western blot. RESULTS Six hub genes were screened, of which HAPLN1, FMOD, NPPB, NPPA, and COMP were overexpressed, whereas NPPC was downregulated in HF. Further research found that silencing HAPLN1 promoted cell viability and reduced apoptosis in Ang II-induced AC16 cells. HAPLN1 knockdown promoted left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS), while decreasing left ventricular end-systolic volume (LVESV) in the HF rat model. HAPLN1 knockdown promoted the levels of GSH and suppressed the levels of MDA, LDH, TNF-α, and IL-6. Mechanistically, silencing HAPLN1 activated the PKA pathway, which were confirmed both in vivo and in vitro. CONCLUSION HAPLN1 knockdown inhibited the progression of HF by activating the PKA pathway, which may provide novel perspectives on the management of HF.
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Affiliation(s)
- Tao Yan
- Department of Cardiology, Zibo Municipal Hospital, Ward 1, No. 139 Huangong Road, Linzi District, Zibo City, Shandong Province, 255400, China
| | - Shushuai Song
- Department of Cardiology, Qingdao Fuwai Cardiovascular Hospital, No. 201 Nanjing Road, Shibei District, Qingdao City, Shandong Province, 266034, China
| | - Wendong Sun
- Department of Cardiology, Zibo Municipal Hospital, No. 139 Huangong Road, Linzi District, Zibo City, Shandong Province, 255400, China
| | - Yiping Ge
- Department of Cardiology, Qingdao Fuwai Cardiovascular Hospital, No. 201 Nanjing Road, Shibei District, Qingdao City, Shandong Province, 266034, China.
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de Miguel-Díez J, Núñez Villota J, Santos Pérez S, Manito Lorite N, Alcázar Navarrete B, Delgado Jiménez JF, Soler-Cataluña JJ, Pascual Figal D, Sobradillo Ecenarro P, Gómez Doblas JJ. Multidisciplinary Management of Patients With Chronic Obstructive Pulmonary Disease and Cardiovascular Disease. Arch Bronconeumol 2024; 60:226-237. [PMID: 38383272 DOI: 10.1016/j.arbres.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/23/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist, increasing the prevalence of both entities and impacting on symptoms and prognosis. CVD should be suspected in patients with COPD who have high/very high risk scores on validated scales, frequent exacerbations, precordial pain, disproportionate dyspnea, or palpitations. They should be referred to cardiology if they have palpitations of unknown cause or angina pain. COPD should be suspected in patients with CVD if they have recurrent bronchitis, cough and expectoration, or disproportionate dyspnea. They should be referred to a pulmonologist if they have rhonchi or wheezing, air trapping, emphysema, or signs of chronic bronchitis. Treatment of COPD in cardiovascular patients should include long-acting muscarinic receptor antagonists (LAMA) or long-acting beta-agonists (LABA) in low-risk or high-risk non-exacerbators, and LAMA/LABA/inhaled corticosteroids in exacerbators who are not controlled with bronchodilators. Cardioselective beta-blockers should be favored in patients with CVD, the long-term need for amiodarone should be assessed, and antiplatelet drugs should be maintained if indicated.
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Affiliation(s)
- Javier de Miguel-Díez
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain.
| | - Julio Núñez Villota
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Salud Santos Pérez
- Servicio de Neumología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito Lorite
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Juan Francisco Delgado Jiménez
- Servicio de Cardiología e Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Medicina, UCM, CIBERCV, Madrid, Spain
| | - Juan José Soler-Cataluña
- Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Valencia, Spain; Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Domingo Pascual Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
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Wang Y, Xu X, Lv Q, Zhao Y, Zhang X, Zang X. Network analysis of symptoms, physiological, psychological and environmental risk factors based on unpleasant symptom theory in patients with chronic heart failure. Int J Nurs Pract 2024; 30:e13246. [PMID: 38389478 DOI: 10.1111/ijn.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Somatic symptoms and related factors in patients with chronic heart failure have been extensively researched. However, more insight into the complex interconnections among these constructs is needed, as most studies focus on them independently from each other. AIMS The aim of this study is to gain a comprehensive understanding of how somatic symptoms and related factors are interconnected among patients with chronic heart failure. METHODS A total of 379 patients were enrolled. Network analysis was used to explore the interconnections among the somatic symptoms and related risk factors. RESULTS The four core symptoms of chronic heart failure were daytime dyspnea, dyspnea when lying down, fatigue and difficulty sleeping. Within the network, the edge weights of depression-anxiety, subjective social support-objective social support, and subjective social support-social support availability were more significant than others. Among physiological, psychological and environmental factors, the edge weights of NYHA-dyspnea, depression-difficulty sleeping, and social support availability-dyspnea when lying down were more significant than others. Depression and anxiety had the highest centrality, indicating stronger and closer connections with other nodes. CONCLUSIONS Psychological and environmental factors stood out in the network, suggesting the potential value of interventions targeting these factors to improve overall health.
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Affiliation(s)
- Yaqi Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xueying Xu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qingyun Lv
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China
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Hua Y, Jiang T, Feng J, Zou M. Negligible effect of vitamin D supplementation on exacerbation in patients with chronic obstructive pulmonary disease: meta-analysis. Biochem Med (Zagreb) 2023; 33:030703. [PMID: 37841773 PMCID: PMC10564157 DOI: 10.11613/bm.2023.030703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/01/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The focus of this meta-analysis was how vitamin D supplementation influences exacerbations in patients with chronic obstructive pulmonary disease (COPD) and vitamin D deficiency (VDD). Materials and methods Cochrane Library, Web of Science, Embase, and PubMed databases have been systematically searched in an attempt to collect randomized controlled trials related to vitamin D supplementation in COPD patients with VDD published in English available by July 2022. Primary outcome indicators included the mean number of exacerbation and rate of exacerbation. Secondary outcome indicators included forced expiratory volume in the first second (FEV1), FEV1/forced vital capacity (FVC) ratio, and serum 25-hydroxyvitamin D (25(OH)D) concentration. Results Five studies involving 522 COPD patients with VDD (defined as 25(OH)D < 50 nmol/L) were included, among them 61 were severely deficient in vitamin D (25(OH)D < 25 nmol/L). The results showed that vitamin D supplementation did not decrease the mean number of exacerbation (standardized mean difference (SMD): - 0.10, 95% CI: - 0.29 to 0.09) and the rate of exacerbation (relative risk (RR): 0.89, 95% CI: 0.76 to 1.04, P = 0.179). Also, its effect on FEV1 (SMD: - 0.06, 95% CI: - 0.30 to 0.17) and FEV1/FVC (SMD: -0.10, 95% CI: - 0.48 to 0.27) remained negligible. However, it could increase the serum 25(OH)D concentration (SMD: 2.44, 95 CI%: 2.20 to 2.68, P < 0.001). Conclusions The effects of vitamin D supplementation on decreasing exacerbation and improving pulmonary function were not significant.
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Affiliation(s)
- Ye Hua
- Department of general surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Ting Jiang
- Department of blood transfusion, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Jiangyi Feng
- Department of general surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Mi Zou
- Respiratory department, The First branch of the first affiliated hospital of Chongqing Medical University, Chongqing, China
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Huang Y, Wang M, Zheng Z, Ma M, Fei X, Wei L, Chen H. Representation of time-varying and time-invariant EMR data and its application in modeling outcome prediction for heart failure patients. J Biomed Inform 2023; 143:104427. [PMID: 37339714 DOI: 10.1016/j.jbi.2023.104427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/18/2023] [Accepted: 06/15/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE To represent a patient record with both time-invariant and time-varying features as a single vector using an end-to-end deep learning model, and further to predict the kidney failure (KF) status and mortality of heart failure (HF) patients. MATERIALS AND METHODS The time-invariant EMR data included demographic information and comorbidities, and the time-varying EMR data were lab tests. We used a Transformer encoder module to represent the time-invariant data, and refined a long short-term memory (LSTM) with a Transformer encoder attached to the top to represent the time-varying data, taking the original measured values and their corresponding embedding vectors, masking vectors, and two types of time intervals as inputs. The proposed representations of patients with time-invariant and time-varying data were used to predict KF status (949 out of 5268 HF patients diagnosed with KF) and mortality (463 in-hospital deaths) for HF patients. Comparative experiments were conducted between the proposed model and some representative machine learning models. Ablation experiments were also performed around the time-varying data representation, including replacing the refined LSTM with the standard LSTM, GRU-D and T-LSTM, respectively, and removing the Transformer encoder and the time-varying data representation module, respectively. The visualization of the attention weights of the time-invariant and time-varying features was used to clinically interpret the predictive performance. We used the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), and the F1-score to evaluate the predictive performance of the models. RESULTS The proposed model achieved superior performance, with average AUROCs, AUPRCs and F1-scores of 0.960, 0.610 and 0.759 for KF prediction and 0.937, 0.353 and 0.537 for mortality prediction, respectively. Predictive performance improved with the addition of time-varying data from longer time periods. The proposed model outperformed the comparison and ablation references in both prediction tasks. CONCLUSIONS Both time-invariant and time-varying EMR data of patients could be efficiently represented by the proposed unified deep learning model, which shows higher performance in clinical prediction tasks. The way to use time-varying data in the current study is hopeful to be used in other kinds of time-varying data and other clinical tasks.
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Affiliation(s)
- Yanqun Huang
- School of Biomedical Engineering, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China.
| | - Muyu Wang
- School of Biomedical Engineering, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China.
| | - Zhimin Zheng
- School of Biomedical Engineering, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China.
| | - Moxuan Ma
- School of Biomedical Engineering, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China.
| | - Xiaolu Fei
- Information Center, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing 100053, China.
| | - Lan Wei
- Information Center, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing 100053, China.
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No.10, Xitoutiao, You An Men, Fengtai District, Beijing 100069, China.
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Ioannides AE, Tayal U, Quint JK. Spirometry in atrial fibrillation: what's the catch? Expert Rev Respir Med 2023; 17:937-950. [PMID: 37937396 DOI: 10.1080/17476348.2023.2279236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION People with COPD rarely have COPD alone, and the commonest co-morbidities occurring with COPD are cardiovascular. Whilst multiple studies have explored the association between major cardiovascular events and COPD, less attention has been paid to arrhythmias, specifically atrial fibrillation (AF). AF and COPD frequently occur together, posing challenges in diagnosis and management. In this review, we describe the relationship between AF and COPD epidemiologically and physiologically, demonstrating the role of spirometry as a diagnostic and disease management tool. AREAS COVERED We provide epidemiological evidence that COPD and AF are independent risk factors for one another, that either disease is highly prevalent amongst people with the other, and that they have shared risk factors; all of which contribute to adverse prognostic. We elucidated common pathophysiological mechanisms implicated in AF-COPD. We ultimately present the epidemiological and physiological evidence with a view to highlight specific areas where we feel spirometry is of value in the management of AF-COPD. EXPERT OPINION AF and COPD commonly co-occur, there is often diagnostic delay, increased risk of reduced cardioversion success, and missed opportunity to intervene to reduce stroke risk. Greater awareness and timelier diagnosis and guideline directed management may improve outcomes for people with both diseases.
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Affiliation(s)
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, UK
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Crisafulli E, Sartori G, Vianello A, Busti F, Nobili A, Mannucci PM, Girelli D. Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both. Intern Emerg Med 2023; 18:523-534. [PMID: 36773107 PMCID: PMC10017574 DOI: 10.1007/s11739-023-03207-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. METHODS We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. RESULTS We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). CONCLUSION In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population.
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Affiliation(s)
- Ernesto Crisafulli
- Respiratory Medicine Unit and Section of Internal Medicine, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Largo L. A. Scuro, 10, 37124, Verona, Italy.
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Giulia Sartori
- Respiratory Medicine Unit and Section of Internal Medicine, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Largo L. A. Scuro, 10, 37124, Verona, Italy
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alice Vianello
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alessandro Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Lin CH, Yeh JK, Lin TY, Lo YL, Chang BJ, Ju JS, Chiu TH, Tung PH, Huang YJ, Lin SM. Influence of chronic obstructive pulmonary disease on long-term hospitalization and mortality in patients with heart failure with reduced ejection fraction. BMC Pulm Med 2023; 23:67. [PMID: 36805703 PMCID: PMC9936736 DOI: 10.1186/s12890-023-02357-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Heart failure with reduced ejection fraction (HFrEF) can coexist with chronic obstructive pulmonary disease (COPD), which complicates the clinical situation and worsens quality of life. The study used standard diagnostic criteria for detecting COPD in hospitalized HFrEF patients and to survey the influence of other comorbidities and medications on the long-term outcomes of HFrEF + COPD patients. METHODS We retrospectively recruited patients hospitalized due to HFrEF in a tertiary medical center and examined and followed up clinical outcomes, including length of hospital stay, mortality, and readmission episodes, for a 5-year period. Risk factors for mortality were analyzed using multivariate analysis. RESULTS Of the 118 hospitalized HFrEF study participants, 68 had concurrent COPD whereas 50 did not. There was a significant increase in the male predominance, smoking history, higher hemoglobin level and increased length of hospital stay in the HF + COPD group than in the HF-only group. Lower left ventricular ejection fraction was found in the HF and COPD comorbidity group. In multivariate analysis, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use independently associated with a beneficial effect on survival in HF patients with COPD. Oral corticosteroid uses and stroke as a comorbidity were independently associated with a shorter time to the first readmission episode. CONCLUSION In HFrEF patients, COPD was associated with a prolonged length of hospital stay. ACEI/ARB use might relate to a beneficial effect on survival in HF patients with COPD. The use of maintenance oral corticosteroid in patients with both HF and COPD should be crucially evaluated to determine the clinical benefit and disadvantages.
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Affiliation(s)
- Chiung-Hung Lin
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Jih-Kai Yeh
- grid.454211.70000 0004 1756 999XDepartment of Cardiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Yu Lin
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Yu-Lun Lo
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Bo-Jui Chang
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Jia-Shiuan Ju
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Tzu-Hsuan Chiu
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Pi-Hung Tung
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Yun-Ju Huang
- grid.454211.70000 0004 1756 999XDepartment of Rheumatology and Immunology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan. .,Department of Respiratory Therapy, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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11
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Kowalczys A, Bohdan M, Wilkowska A, Pawłowska I, Pawłowski L, Janowiak P, Jassem E, Lelonek M, Gruchała M, Sobański P. Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice. Front Cardiovasc Med 2022; 9:895495. [PMID: 36237915 PMCID: PMC9551106 DOI: 10.3389/fcvm.2022.895495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.
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Affiliation(s)
- Anna Kowalczys
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Anna Kowalczys,
| | - Michał Bohdan
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alina Wilkowska
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Leszek Pawłowski
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Piotr Janowiak
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Sobański
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
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12
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Diagnostic Values of Blood Urea Nitrogen (BUN), Creatinine (Cr), and the Ratio of BUN to Cr for Distinguishing Heart Failure from Asthma and Chronic Obstructive Pulmonary Disease. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4586458. [PMID: 35912149 PMCID: PMC9334060 DOI: 10.1155/2022/4586458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022]
Abstract
Background In clinical practise, it can be challenging to tell the difference between asthma and chronic obstructive pulmonary disease (COPD) and heart failure (HF), which share comparable dyspnea symptoms. We aimed to examine whether renal function indexes blood urea nitrogen (BUN), creatinine (Cr), and the ratio of BUN to Cr (BUN/Cr) can be used to distinguish HF from asthma and COPD. Methods A total of 170 patients were admitted for dyspnea symptoms in this retrospective study. There are 69 patients with HF (HF group), 50 patients with asthma (asthma group), and 51 patients diagnosed with COPD (COPD group). The levels of BUN, Cr, and the ratio of BUN/Cr in the three groups were compared. Student's t-test or the one-way analysis of variance (ANOVA) test was used to compare means. Using the area under the receiver operating characteristic curve, model differentiation was evaluated (AUC). Z-test comparisons of AUC were carried out. Results Compared with the asthma/COPD group (asthma group + COPD group) or the COPD group, the levels of BUN and Cr were raised in the HF group, while there was no significant difference of the BUN/Cr ratio. Compared with those in the asthma group, the levels of BUN, Cr, and BUN/Cr ratio were significantly increased in the HF group (all p < 0.05), whereas no significant differences of BUN, Cr, and BUN/Cr ratio were found between asthma and COPD. The AUC in distinguishing HF from asthma/COPD were 0.736 and 0.751 for BUN and Cr, respectively, and no significant difference was observed between BUN and Cr. The cutoff values (specificity, sensitivity, and Youden index) in distinguishing between HF and asthma/COPD were 20.45 mg/dL (79.21%, 56.52%, and 0.357) for BUN and 0.782 mg/dL (72.28%, 68.12%, and 0.404) for Cr, respectively. Conclusions BUN and Cr showed accurate and reliable diagnostic values which could be potential biomarkers for differentiating HF from asthma and/or COPD.
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13
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Wessman T, Tofik R, Ruge T, Melander O. Associations between biomarkers of multimorbidity burden and mortality risk among patients with acute dyspnea. Intern Emerg Med 2022; 17:559-567. [PMID: 34417729 PMCID: PMC8964555 DOI: 10.1007/s11739-021-02825-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022]
Abstract
The patients' burden of comorbidities is a cornerstone in risk assessment, clinical management and follow-up. The aim of this study was to evaluate if biomarkers associated with comorbidity burden can predict outcome in acute dyspnea patients. We included 774 patients with dyspnea admitted to an emergency department and measured 80 cardiovascular protein biomarkers in serum collected at admission. The number of comorbidities for each patient were added, and a multimorbidity score was created. Eleven of the 80 biomarkers were independently associated with the multimorbidity score and their standardized and weighted values were summed into a biomarker score of multimorbidities. The biomarker score and the multimorbidity score, expressed per standard deviation increment, respectively, were related to all-cause mortality using Cox Proportional Hazards Model. During long-term follow-up (2.4 ± 1.5 years) 45% of the patients died and during short-term follow-up (90 days) 12% died. Through long-term follow-up, in fully adjusted models, the HR (95% CI) for mortality concerning the biomarker score was 1.59 (95% CI 1348-1871) and 1.18 (95% CI 1035-1346) for the multimorbidity score. For short-term follow-up, in the fully adjusted model, the biomarker score was strongly related to 90-day mortality (HR 1.98, 95% CI 1428-2743), whereas the multimorbidity score was not significant. Our main findings suggest that the biomarker score is superior to the multimorbidity score in predicting long and short-term mortality. Measurement of the biomarker score may serve as a biological fingerprint of the multimorbidity score at the emergency department and, therefore, be helpful for risk prediction, treatment decisions and need of follow-up both in hospital and after discharge from the emergency department.
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Affiliation(s)
- Torgny Wessman
- grid.411843.b0000 0004 0623 9987Department of Emergency Medicine, Skåne University Hospital, Ruth Lundskogs gata 3, 20502 Malmö, Sweden
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Rafid Tofik
- grid.411843.b0000 0004 0623 9987Department of Emergency Medicine, Skåne University Hospital, Ruth Lundskogs gata 3, 20502 Malmö, Sweden
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Thoralph Ruge
- grid.411843.b0000 0004 0623 9987Department of Emergency Medicine, Skåne University Hospital, Ruth Lundskogs gata 3, 20502 Malmö, Sweden
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Olle Melander
- grid.411843.b0000 0004 0623 9987Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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14
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Wang T, Xu H, Zhu Y, Sun X, Chen J, Liu B, Zhao Q, Zhang Y, Liu L, Fang J, Xie Y, Liu S, Wu R, Song X, He B, Huang W. Traffic-related air pollution associated pulmonary pathophysiologic changes and cardiac injury in elderly patients with COPD. JOURNAL OF HAZARDOUS MATERIALS 2022; 424:127463. [PMID: 34687998 DOI: 10.1016/j.jhazmat.2021.127463] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
Traffic-related air pollution (TRAP) has shown enormous environmental toxicity, but its cardiorespiratory health impact on chronic obstructive pulmonary disease (COPD) has been less studied. We followed a panel of 45 COPD patients with 4 repeated clinical visits across 14 months in a traffic-predominated urban area of Beijing, China, with concurrent measurements of TRAP metrics (fine particulate matter, black carbon, oxides of nitrogen and carbon monoxide). Linear mixed-effect models were performed to evaluate the associations and potential pathways linking traffic pollution to indicators of spirometry, cardiac injury, inflammation and oxidative stress. We observed that interquartile range increases in moving averages of TRAP exposures at prior up to 7 days were associated with significant reductions in large and small airway functions, namely decreases in forced vital capacity of 3.1-9.3% and forced expiratory flow 25-75% of 5.9-16.4%. Higher TRAP levels were also associated with worsening of biomarkers relevant to lung injury (hepatocyte growth factor and surfactant protein D) and cardiac injury (high-sensitivity cardiac troponin I, B-type natriuretic peptide and soluble ST2), as well as enhanced airway/systemic inflammation and oxidative stress. Mediation analyses showed that TRAP exposures may prompt cardiac injury, possibly via worsening pulmonary pathophysiology. These findings highlight the importance of traffic pollution control priority in urban areas.
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Affiliation(s)
- Tong Wang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Hongbing Xu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Yutong Zhu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Xiaoyan Sun
- Division of Respiration, Peking University Third Hospital, Beijing, China
| | - Jie Chen
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Institute for Risk Assessment Sciences, University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Beibei Liu
- Division of Respiration, Peking University Third Hospital, Beijing, China
| | - Qian Zhao
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Yi Zhang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Lingyan Liu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Jiakun Fang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Yunfei Xie
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Shuo Liu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rongshan Wu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - Xiaoming Song
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Bei He
- Division of Respiration, Peking University Third Hospital, Beijing, China.
| | - Wei Huang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China.
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15
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Zhang D, Li H, Tian X, Zhang S. Effects of enteral nutrition on heart function, inflammatory markers and immune function in elderly patients with chronic heart failure. Pak J Med Sci 2022; 38:302-309. [PMID: 35035444 PMCID: PMC8713206 DOI: 10.12669/pjms.38.1.4451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/17/2021] [Accepted: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: To evaluate the effect of enteral nutrition on heart function, inflammatory markers and immune function in elderly patients with chronic heart failure and its clinical significance. Methods: Eighty patients with moderate and severe heart failure admitted to the Cardiology Intensive Care Unit (CCU) of Baoding First Central Hospital from May 2019 to May 2020 were included in this study and randomly divided into two groups: the experimental group and the control group, with 40 patients in each group. The experimental group was given enteral nutrition support therapy on the basis of conventional therapy for one month, while the control group was given restricted salt and water intake on the basis of conventional therapy, and patients were given free diet according to their wishes. The changes in heart function before and after treatment, changes in inflammatory factors such as TNF-a, CRP, IL-6, changes in levels of immunoglobulins such as IgA, IgM, and IgG, and the improvement of the performance status of the two groups were compared and analyzed. Results: After treatment, indicators such as BNP, LVEDD, LVEF and 6min walking distance in the experimental group were significantly improved compared with the control group, with statistically significant differences (p<0.05), and the levels of inflammatory factors such as TNF-a, CRP and IL-6 in the experimental group were significantly reduced compared with those in the control group (p=0.00). The levels of IgG, IgA, IgM and other immunoglobulins in the experimental group improved more significantly after treatment than those in the control group, with statistically significant differences (IgG, IgA, p=0.00; IgM, p=0.01). Moreover, the experimental group was significantly superior to the control group in the improvement rate of performance status score (ECOG) after treatment (p=0.04); The incidence of gastrointestinal adverse reactions in the experimental group was 20%, and that in the control group was 15%. No statistically significant difference can be observed in the gastrointestinal tolerance of both groups (p=0.56). Conclusions: Reasonable enteral nutrition boasts a variety of benefits for the recovery of elderly patients with chronic heart failure. With reasonable enteral nutrition, the heart function of elderly patients with chronic heart failure can be significantly improved, inflammatory factors can be reduced, immunity and performance status can be enhanced, and gastrointestinal tolerance can be ameliorated without obvious gastrointestinal reactions.
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Affiliation(s)
- Dan Zhang
- Dan Zhang, Department of Outpatient, Baoding First Central Hospital, Baoding, Hebei 071000, China
| | - Hongli Li
- Hongli Li, Department of Cardio-vascular Baoding First Central Hospital, Baoding, Hebei 071000, China
| | - Xiang Tian
- Xiang Tian, Department of Cardio-vascular Baoding First Central Hospital, Baoding, Hebei 071000, China
| | - Sujuan Zhang
- Sujuan Zhang Department of Outpatient, Baoding First Central Hospital, Baoding, Hebei 071000, China
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16
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Khalid K, Padda J, Komissarov A, Colaco LB, Padda S, Khan AS, Campos VM, Jean-Charles G. The Coexistence of Chronic Obstructive Pulmonary Disease and Heart Failure. Cureus 2021; 13:e17387. [PMID: 34584797 PMCID: PMC8457262 DOI: 10.7759/cureus.17387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/21/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic illness that is widely prevalent within the United States and has been frequently associated with heart failure (HF). COPD is associated with progressive damage and inflammation of the airways leading to airflow obstruction and inadequate gas exchange. HF represents a decline in the normal functioning of the heart resulting in insufficient pumping of blood through the circulatory system. COPD and HF present with similar signs and symptoms with some variation. There are many specific diagnostic tests and treatment modalities which we use to diagnose COPD and HF, but it becomes an issue when you come across a patient who has both conditions simultaneously. For example, attempting to use an X-ray to diagnose HF in a COPD patient is next to impossible because the results are manipulated by the COPD disease process. This is the case with many other diagnostic tests such as an electrocardiogram (ECG), chest radiography (X-ray), B-type natriuretic peptide (BNP), echocardiogram, cardiac magnetic resonance imaging (CMR), pulmonary function test (PFT), arterial blood gas (ABG), and exercise stress testing. When a patient has both COPD and HF, it becomes more difficult to treat. Many treatments for HF have negative impacts on COPD patients and vice-versa, whereas some have also shown positive clinical outcomes in both diseases. It is agreeable that treatment has to be patient-centered and it can vary from case to case depending on the severity of the disease. Ultimately, in this review, we discuss COPD and HF and how they interplay in their diagnostic and treatment modalities to gain a better understanding of how to effectively manage patients who have been diagnosed with both conditions.
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Affiliation(s)
- Khizer Khalid
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Jaskamal Padda
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, Avalon University School of Medicine, Willemstad, CUW
| | - Anton Komissarov
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Lanson B Colaco
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Sandeep Padda
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, Avalon University School of Medicine, Willemstad, CUW
| | - Armughan S Khan
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Gutteridge Jean-Charles
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, Advent Health & Orlando Health Hospital, Orlando, USA
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17
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Kubota Y, Tay WT, Teng THK, Asai K, Noda T, Kusano K, Suzuki A, Hagiwara N, Hisatake S, Ikeda T, Yasuoka R, Kurita T, Shimizu W. Impact of beta-blocker use on the long-term outcomes of heart failure patients with chronic obstructive pulmonary disease. ESC Heart Fail 2021; 8:3791-3799. [PMID: 34189870 PMCID: PMC8497364 DOI: 10.1002/ehf2.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 05/03/2021] [Accepted: 06/08/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS The number of patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) is increasing in Asia, and these conditions often coexist. We previously revealed a tendency of beta-blocker underuse among patients with HF with reduced ejection fraction (HFrEF) and COPD in Asian countries other than Japan. Here, we evaluated the impact of cardio-selective beta-blocker use on the long-term outcomes of patients with HF and COPD. METHODS AND RESULTS Among the 5232 patients with HFrEF (left ventricular ejection fraction of <40%) prospectively enrolled from 11 Asian regions in the ASIAN-HF registry, 412 (7.9%) had a history of COPD. We compared the clinical characteristics and long-term outcomes of the patients with HF and COPD according to the use and type of beta-blockers used: cardio-selective beta-blockers (n = 149) vs. non-cardio-selective beta-blockers (n = 124) vs. no beta-blockers (n = 139). The heart rate was higher, and the outcome was poorer in the no beta-blocker group than in the beta-blocker groups. The 2 year all-cause mortality was significantly lower in the non-cardio-selective beta-blocker group than in the no beta-blocker group. Further, the cardiovascular mortality significantly decreased in the non-cardio-selective beta-blocker group before (hazard ratio: 0.36; 95% confidence interval: 0.18-0.73; P = 0.004) and after adjustments (hazard ratio: 0.37; 95% confidence interval: 0.19-0.73; P = 0.005), but not in the cardio-selective beta-blocker group. CONCLUSIONS Beta-blockers reduced the all-cause mortality of patients with HFrEF and COPD after adjusting for age and heart rate, although the possibility of selection bias could not be completely excluded due to multinational prospective registry.
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Affiliation(s)
- Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-0022, Japan
| | | | | | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-0022, Japan
| | - Takashi Noda
- Division of Cardiology, Department of Internal Medicine, National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Kengo Kusano
- Division of Cardiology, Department of Internal Medicine, National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shinji Hisatake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Omori Hospital, Tokyo, Japan
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Omori Hospital, Tokyo, Japan
| | - Ryobun Yasuoka
- Division of Cardiology, Department of Internal Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Takashi Kurita
- Division of Cardiology, Department of Internal Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-0022, Japan
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18
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Li H, Song S, Kong Z, Zhu Z, Liu Y, Zuo S, Yin S. Regulatory Effects of Andrographolide on Lung Tissue Inflammation and Th17/Treg in Rats with Chronic Obstructive Pulmonary Disease Induced by Smoking and Lipopolysaccharide. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The pathogenesis of Chronic obstructive pulmonary disease (COPD) is complex, and lung tissue inflammation and Th17/Treg imbalance are the key factors causing lung dysfunction. We constructed a rat COPD model induced by smoking and lipopolysaccharide to explore andrographolide’s
regulation on lung inflammation and Th17/Treg in COPD rats. By contrast, the study found that normal rats, COPD rats forced expiratory volume of 0.3 seconds (FEV0.3), FEV0.3/forced vital capacity (FVC), and peak expiratory flow (PEF) levels decreased. In addition,
the levels of IL-8, TNF-α, IL-17, and IL-6 in alveolar lavage fluid increased, and the level of IL-10 decreased. Concurrently, the total number of white blood cells, monocytes and macrophages, neutrophils, and lymphocytes increased. Meanwhile, the contents of CD25, CD4, and Foxp3 in
lung tissue all increased, and the protein levels of HMGB1, TLR4, and p65 increased. After treatment with andrographolide, the levels of FEV0.3, FEV0.3/FVC, and PEF increased, proving the increase was positively correlated with the concentration of andrographolide. The
levels of IL-8, TNF-α, IL-17, and IL-6 in rat alveolar lavage fluid decreased, and the level of IL-10 sequentially. The total number of white blood cells, the number of monocytes and macrophages, the number of lymphocytes, and the neutral Granulocytes decreased significantly. And the
contents of CD25, CD4, and Foxp3 in lung tissue significantly decreased, and the protein levels of HMGB1, TLR4, and p65 significantly decreased. The above results indicate that andrographolide might be a potential COPD treatment approach. Andrographolide improves the lung function of rats
with COPD, reduces lung inflammation, regulates Th17/Treg balance, and its mechanism may be related to HMGB1/TLR4/NF-кB signaling.
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Affiliation(s)
- Hong Li
- Department of Respiratory Medicine, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
| | - Shuang Song
- Department of Respiratory Medicine, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
| | - Zhibin Kong
- Department of Respiratory Medicine, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
| | - Zhen Zhu
- Department of Respiratory Medicine, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
| | - Yi Liu
- Department of Respiratory Medicine, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
| | - Sheng Zuo
- Department of Geriatrics, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
| | - Shaojun Yin
- Department of Respiratory Medicine, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
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19
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Yang T, Chen C, Chen Z. The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis. BMC Pulm Med 2021; 21:34. [PMID: 33472612 PMCID: PMC7816324 DOI: 10.1186/s12890-020-01374-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 12/14/2020] [Indexed: 01/14/2023] Open
Abstract
Background It is necessary to analyze the CT pulmonary vascular parameters and disease severity in chronic obstructive pulmonary disease (COPD) patients to provide evidence support for the management of COPD. Methods COPD patients on acute exacerbation admitted to our hospital from COPD patients from January 2019 to March 2020 was selected. The characteristics and ratio of the cross-sectional area (CSA) of small pulmonary vessels to the total area of the lung field, and the ratio of pulmonary artery and aorta (PA/A) cross-sectional diameter in patients with COPD were analyzed. Results A total of 128 COPD patients were included. There were significant differences in the duration of COPD, smoking history, the PaO2, PaCO2, pH, and FEV1, FVC and FEV1/FVC among COPD patients with different severity (all p < 0.05). The duration of COPD, smoking, PaO2, PaCO2, CSA and PA/A were correlated with the COPD severity (all p < 0.05). Both CSA, PA/A were correlated with post BD FEV1 (all p < 0.05). The cutoff value of CSA and PA/A for the diagnosis of severe COPD was 0.61 and 0.87 respectively, and the AUC of CSA and PA/A for the diagnosis of severe COPD was 0.724 and 0.782 respectively. Conclusions Patients with CSA ≤ 0.61 and PA/A ≥ 0.87 may have higher risks for severe COPD, and more studies are needed in the future to further elucidate the management of COPD.
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Affiliation(s)
- Tao Yang
- Imaging Department, Linyi Central Hospital, Linyi, 276400, Shandong, China
| | - Chihua Chen
- Radiology Department, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan, 430015, Hubei, China
| | - Zhongyuanlong Chen
- Department of Radiology, Chest Hospital of Xinjiang Uygur Autonomous Region of the PRC, No. 106, Yan'an road, Urumqi, 830049, Xinjiang, China.
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20
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Wendpap CDR, Santos TDD, Lüdke E, Pasqualoto AS, Silveira AFD, Albuquerque IMD. Health status can predict diaphragmatic muscle thickness in COPD: pilot study. FISIOTERAPIA EM MOVIMENTO 2021. [DOI: 10.1590/fm.2021.34124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Among the systemic implications of chronic obstructive pulmonary disease (COPD) there are changes in the diaphragm and impact on health status. However, there are few studies on the possible relationship between these variables, and whether health status could predict diaphragmatic muscle thickness (DMT). Objective: To investigate whether there is a relationship between DMT and the prognostic mortality index Body Mass-Index, Airway Obstruction, Dyspnea and Exercise Capacity (BODE), dyspnea and health status, and to investigate whether health status can predict DMT in patients with COPD entering a pulmonary rehabilitation program. Methods: This is a pilot study with a cross-sectional design. Diaphragmatic muscle thickness was evaluated using ultrasound; health status through the COPD Assessment Test (CAT); the sensation of dyspnea by the modified Medical Research Council scale; and mortality, using the BODE index. Results: The sample consisted of 13 patients (68.69 ± 9.3 years) classified as having moderate to severe COPD. There was a strong and inverse correlation between diaphragmatic muscle thickness and health status (r = -0.735; p = 0.004). Simple regression analysis demonstrated that health status influenced diaphragmatic muscle thickness (β = -0.002; IC 95% - 0.004 to -0.001; p = 0.004), explaining 49% of the variance. However, no correlations were observed between diaphragmatic muscle thickness with dyspnea (r = 0.005; p = 0.985) or with the BODE mortality index (r = -0.219; p = 0.472). Conclusion: This pilot study demonstrated a strong inverse correlation between health status and DMT. In addition, health status was able to predict DMT in patients with COPD.
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21
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MAIEREAN AD, TONCA C, PERNE Mirela Georgiana, DOGARU G, RAJNOVEANU R, CHIS AF, MOTOC NS, BORDEA RI. Music, A “Body-Mind Medicine” In Rehabilitation Programs of Patients with Chronic Obstructive Pulmonary Disease. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by dyspnea and chronic cough. The main risk factor is cigarette smoking, but there are other ones implicated in the COPD etiology such as air pollution, childhood asthma, aging, chemical exposure, dietary factors, and genetic predisposition. Besides, COPD is associated with several comorbidities that influence prognostic and management, like asthma, lung cancer, obstructive sleep apnea, cardiovascular disease, metabolic syndrome, and depression or anxiety. The management is multidisciplinary and its role is to ease symptoms, prevent complications, slow disease progression, and improve the quality of life. In the last years, many alternative techniques have been implemented such as speleotherapy, halotherapy, muscular training, neuromuscular electrostimulation, acupuncture, thermotherapy, and music therapy. From those, music therapy has become a form of “mind-body medicine” indispensable in rehabilitation programs, whether used actively or passively, and has gained a lot of interest in alternative medicine.
Keywords: COPD, music therapy, alternative medicine,
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Affiliation(s)
| | - Claudia TONCA
- Clinical Hospital of Pneumology “Leon Daniello” Cluj-Napoca, Romania
| | | | - Gabriela DOGARU
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Ana Florica CHIS
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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22
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Heart, lungs, and muscle interplay in worsening activity-related breathlessness in advanced cardiopulmonary disease. Curr Opin Support Palliat Care 2020; 14:157-166. [PMID: 32740275 DOI: 10.1097/spc.0000000000000516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Activity-related breathlessness is a key determinant of poor quality of life in patients with advanced cardiorespiratory disease. Accordingly, palliative care has assumed a prominent role in their care. The severity of breathlessness depends on a complex combination of negative cardiopulmonary interactions and increased afferent stimulation from systemic sources. We review recent data exposing the seeds and consequences of these abnormalities in combined heart failure and chronic obstructive pulmonary disease (COPD). RECENT FINDINGS The drive to breathe increases ('excessive breathing') secondary to an enlarged dead space and hypoxemia (largely COPD-related) and heightened afferent stimuli, for example, sympathetic overexcitation, muscle ergorreceptor activation, and anaerobic metabolism (largely heart failure-related). Increased ventilatory drive might not be fully translated into the expected lung-chest wall displacement because of the mechanical derangements brought by COPD ('inappropriate breathing'). The latter abnormalities, in turn, negatively affect the central hemodynamics which are already compromised by heart failure. Physical activity then decreases, worsening muscle atrophy and dysfunction. SUMMARY Beyond the imperative of optimal pharmacological treatment of each disease, strategies to lessen ventilation (e.g., walking aids, oxygen, opiates and anxiolytics, and cardiopulmonary rehabilitation) and improve mechanics (heliox, noninvasive ventilation, and inspiratory muscle training) might mitigate the burden of this devastating symptom in advanced heart failure-COPD.
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23
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Kostikas K, Rhee CK, Hurst JR, Agostoni P, Cao H, Fogel R, Jones R, Kocks JWH, Mezzi K, Wan Yau Ming S, Ryan R, Price DB. Adequacy of Therapy for People with Both COPD and Heart Failure in the UK: Historical Cohort Study. Pragmat Obs Res 2020; 11:55-66. [PMID: 32581622 PMCID: PMC7276330 DOI: 10.2147/por.s250451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) and heart failure (HF) often occur concomitantly, presenting diagnostic and therapeutic challenges for clinicians. We examined the characteristics of patients prescribed adequate versus inadequate therapy within 3 months after newly diagnosed comorbid COPD or HF. Patients and Methods Eligible patients in longitudinal UK electronic medical record databases had pre-existing HF and newly diagnosed COPD (2017 GOLD groups B/C/D) or pre-existing COPD and newly diagnosed HF. Adequate COPD therapy was defined as long-acting bronchodilator(s) with/without inhaled corticosteroid; adequate HF therapy was defined as beta-blocker plus angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker. Results Of 2439 patients with HF and newly diagnosed COPD (mean 75 years, 61% men), adequate COPD therapy was prescribed for 726 (30%) and inadequate for 1031 (42%); 682 (28%) remained untreated for COPD. Adequate (vs inadequate) COPD therapy was less likely for women (35%) than men (45%), smokers (36%) than ex-/non-smokers (45%), and non-obese (41%) than obese (47%); spirometry was recorded for 57% prescribed adequate versus 35% inadequate COPD therapy. Of 12,587 patients with COPD and newly diagnosed HF (mean 75 years, 60% men), adequate HF therapy was prescribed for 2251 (18%) and inadequate for 5332 (42%); 5004 (40%) remained untreated for HF. Adequate (vs inadequate) HF therapy was less likely for smokers (27%) than ex-/non-smokers (32%) and non-obese (30%) than obese (35%); spirometry was recorded for 65% prescribed adequate versus 39% inadequate HF therapy. Conclusion Many patients with comorbid COPD/HF receive inadequate therapy after new diagnosis. Improved equity of access to integrated care is needed for all patient subgroups.
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Affiliation(s)
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Rupert Jones
- Plymouth University, Faculty of Medicine and Dentistry, Plymouth, UK
| | - Janwillem W H Kocks
- Observational and Pragmatic Research Institute, Singapore, Singapore.,General Practitioners Research Institute, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Ronan Ryan
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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24
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Sirois C, Ouali A, Simard M. Polypharmacy among Older Individuals with COPD: Trends between 2000 and 2015 in Quebec, Canada. COPD 2019; 16:234-239. [PMID: 31401851 DOI: 10.1080/15412555.2019.1646716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The treatment of chronic obstructive pulmonary disease (COPD) and concomitant diseases requires several medications. Yet there is little data on how the pharmacological burden progressed over time among older individuals with COPD. We aimed to: 1) describe the proportion of older adults with COPD in Quebec, Canada, that were exposed to polypharmacy (≥10, ≥15 or ≥20 medications/year) between 2000 and 2015; 2) calculate the proportion of individuals receiving specific prescriptions for COPD during this period. We conducted a population-based cohort study with the Quebec Integrated Chronic Disease Surveillance System. Individuals aged ≥66 years with COPD and covered by the universal public drug plan were included. We calculated the total number of drugs used at least once by each individual during each of the studied years, and used age-standardized proportions to compare proportions of users between the years. The average number of drugs used increased from 12.0 in 2000 to 14.8 in 2015. The proportion of individuals exposed to polypharmacy increased (≥10 drugs: 62.0% to 74.6%;≥15 drugs: 31.2% to 45.4%; ≥20 drugs: 12.3% to 22.4%). The proportion of individuals receiving long-acting bronchodilators increased from 18.7% in 2000 to 69.6% in 2015. The use of short-acting bronchodilators decreased from 81.5% to 67.9%, and that of inhaled corticosteroids from 60.6% to 26.0%. The proportion of users of methylxanthines decreased from 15.0% to 1.9%. Older individuals with COPD are increasingly exposed to polypharmacy. Identifying which polypharmacy is beneficial is a priority.
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Affiliation(s)
- Caroline Sirois
- Faculty of Medicine, Université Laval , Québec , Canada.,Institut national de santé publique du Québec , Québec , Canada.,Centre d'excellence sur le vieillissement de Québec , Québec , Canada
| | - Amina Ouali
- Faculty of Medicine, Université Laval , Québec , Canada
| | - Marc Simard
- Institut national de santé publique du Québec , Québec , Canada
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