dc.creator | Méndez Bailón, Manuel | es |
dc.creator | Lorenzo Villalba, Noel | es |
dc.creator | Romero Correa, Miriam | es |
dc.creator | Josa Laorden, Claudia | es |
dc.creator | Inglada Galiana, Luis | es |
dc.creator | Menor Campos, Eva | es |
dc.creator | Aramburu Bodas, Oscar | es |
dc.creator | Salamanca Bautista, María del Prado | es |
dc.date.accessioned | 2023-05-02T13:55:48Z | |
dc.date.available | 2023-05-02T13:55:48Z | |
dc.date.issued | 2022 | |
dc.identifier.citation | Méndez Bailón, M., Lorenzo Villalba, N., Romero Correa, M., Josa Laorden, C., Inglada Galiana, L., Menor Campos, E.,...,Salamanca Bautista, M.d.P. (2022). Chronic Obstructive Pulmonary Disease in Elderly Patients with Acute and Advanced Heart Failure: Palliative Care Needs—Analysis of the EPICTER Study. Journal of Clinical Medicine (JCM), 11 (13), 3709. https://doi.org/10.1097/PTS.0000000000000929. | |
dc.identifier.issn | 2077-0383 | es |
dc.identifier.uri | https://hdl.handle.net/11441/144936 | |
dc.description.abstract | There are studies that evaluate the association between chronic obstructive
pulmonary disease (COPD) and heart failure (HF) but there is little evidence regarding the prognosis
of this comorbidity in older patients admitted for acute HF. In addition, little attention has been given
to the extracardiac and extrapulmonary symptoms presented by patients with HF and COPD in more
advanced stages. The aim of this study was to evaluate the prognostic impact of COPD on mortality
in elderly patients with acute and advanced HF and the clinical manifestations and management
from a palliative point of view. Methods: The EPICTER study (“Epidemiological survey of advanced
heart failure”) is a cross-sectional, multicenter project that consecutively collected patients admitted
for HF in 74 Spanish hospitals. Demographic, clinical, treatment, organ-dependent terminal criteria (NYHA III-IV, LVEF <20%, intractable angina, HF despite optimal treatment), and general terminal
criteria (estimated survival <6 months, patient/family acceptance of palliative approach, and one of
the following: evidence of HF progression, multiple Emergency Room visits or admissions in the
last six months, 10% weight loss in the last six months, and functional impairment) were collected.
Terminal HF was considered if the patient met at least one organ-dependent criterion and all the
general criteria. Both groups (HF with COPD and without COPD) were compared. A Kaplan–Meier
survival analysis was performed to evaluate the presence of COPD on the vital prognosis of patients
with HF. Results: A total of 3100 patients were included of which 812 had COPD. In the COPD
group, dyspnea and anxiety were more frequently observed (86.2% vs. 75.3%, p = 0.001 and 35.4%
vs. 31.2%, p = 0.043, respectively). In patients with a history of COPD, presentation of HF was in
the form of acute pulmonary edema (21% vs. 14.4% in patients without COPD, p = 0.0001). Patients
with COPD more frequently suffered from advanced HF (28.9% vs. 19.4%; p < 0.001). Consultation
with the hospital palliative care service during admission was more frequent when patients with
HF presented with associated COPD (94% vs. 6.8%; p = 0.036). In-hospital and six-month follow-up
mortality was 36.5% in patients with COPD vs. 30.7% in patients without COPD, p = 0.005. The mean
number of hospital admissions during follow-up was higher in patients with HF and COPD than in
those with isolated HF (0.63 ± 0.98 vs. 0.51 ± 0.84; p < 0.002). Survival analysis showed that patients
with a history of COPD had fewer survival days during follow-up than those without COPD (log
Rank chi-squared 4.895 and p = 0.027). Conclusions: patients with HF and COPD had more severe
symptoms (dyspnea and anxiety) and also a worse prognosis than patients without COPD. However,
the prognosis of patients admitted to our setting is poor and many patients with HF and COPD
may not receive the assessment and palliative care support they need. Palliative care is necessary in
chronic non-oncologic diseases, especially in multipathologic and symptom-intensive patients. This
is a clinical care aspect to be improved and evaluated in future research studies. | es |
dc.format | application/pdf | es |
dc.format.extent | 9 p. | es |
dc.language.iso | eng | es |
dc.publisher | MDPI | es |
dc.relation.ispartof | Journal of Clinical Medicine (JCM), 11 (13), 3709. | |
dc.rights | Atribución 4.0 Internacional | * |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | * |
dc.subject | Chronic obstructive pulmonary disease | es |
dc.subject | Advance heart failure | es |
dc.subject | Palliative care | es |
dc.title | Chronic Obstructive Pulmonary Disease in Elderly Patients with Acute and Advanced Heart Failure: Palliative Care Needs—Analysis of the EPICTER Study | es |
dc.type | info:eu-repo/semantics/article | es |
dcterms.identifier | https://ror.org/03yxnpp24 | |
dc.type.version | info:eu-repo/semantics/publishedVersion | es |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | es |
dc.contributor.affiliation | Universidad de Sevilla. Departamento de Medicina | es |
dc.relation.publisherversion | https://www.mdpi.com/2077-0383/11/13/3709 | es |
dc.identifier.doi | 10.1097/PTS.0000000000000929 | es |
dc.journaltitle | Journal of Clinical Medicine (JCM) | es |
dc.publication.volumen | 11 | es |
dc.publication.issue | 13 | es |
dc.publication.initialPage | 3709 | es |