COPD still affects treatment received after heart attack

By Lauretta Ihonor

Patients with chronic obstructive pulmonary disease (COPD) receive less aggressive treatment after hospitalization for acute myocardial infarction (AMI) than those without the lung condition, US study results show.

Mihaela Stefan, from Baystate Medical Center in Springfield, Massachusetts, and colleagues say that COPD patients also had a higher risk for death during hospitalization and at 30 days after discharge.

The authors comment: "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 patients with AMI and underlying COPD did not improve."

The study consisted of 6290 patients with a mean age of 71 years who were admitted to hospital with AMI and was conducted between 1997 and 2007.

In all, 1080 patients had COPD and 5210 did not.

As reported in Chest, COPD patients were older than non-COPD patients, and were more likely to have a history of other cardiovascular conditions, including angina, heart failure (HF), hypertension, stroke, and diabetes. Patients with COPD were 56% less likely to be treated with beta blockers than those without COPD, 30% less likely to be treated with lipid-lowering medication, and 44% less likely to have undergone cardiac catheterization. They were also less likely to have undergone percutaneous coronary intervention and coronary artery bypass graft surgery during their index hospitalization, and more likely to have been prescribed calcium channel blockers.

Among the study group, inpatient death was more common among COPD patients than non-COPD patients, at respective rates of 13.5% and 10.1%. The same trend was seen during the 30-day period after discharge, with respective death rates of 18.7% and 13.2%.

Adjustment for multiple confounding factors, such as smoking and medication use, revealed that the presence of COPD raised the risk for inpatient death and 30-day postdischarge death in AMI patients by 25.0% and 31.0%, respectively.

Other cardiac conditions associated with poor outcomes after AMI were found to occur more frequently among COPD patients than COPD-free patients.

Specifically, atrial fibrillation was observed in 24.3% of COPD patients and 18.2% of non-COPD patients, while HF occurred in 52.5% and 34.8%, respectively.

Median length of hospital stay was 1 day longer for COPD patients than for non-COPD patients.

"The use of evidence-based therapies for all patients with AMI increased between 1997 and 2007," but this change did not affect clinical outcomes, say Stefan et al.

They therefore conclude that "careful consideration is necessary to treat established cardiovascular risk factors and optimize cardiac therapies in patients with COPD."

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