Care has improved for patients with chronic obstructive pulmonary disease (COPD) who are hospitalized for acute myocardial infarction (MI), but they are still less likely to receive certain therapies than acute MI patients without COPD, according to a new study.
Researchers used data from the Worcester Heart Attack Study to determine differences in clinical characteristics, outcomes and treatment in patients with and without COPD who were hospitalized for acute MI at medical centers in Worcester, Mass., from 1997 to 2007. Demographics, length of stay, symptoms at presentation, medical history, characteristics of acute MI, laboratory measurements, discharge status and complications were all examined, and use of therapies including cardiac medications, cardiac catheterization, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) was determined. A patient was considered to have COPD if his or her medical record described clinical or radiographic evidence of the disorder. Researchers looked for differences in demographics, clinical characteristics, and treatments received in patients with COPD versus those without. The association of COPD with mortality and complication rates was also determined. The study results were published online Dec. 29 by Chest.
Overall, 17% of the 6,290 patients hospitalized for acute MI during the study period also had COPD. More than half (56%) of all patients were men, and the average age was 71 years. Patients with acute MI who also had COPD were less likely to receive interventional procedures during their initial hospitalization and were also less likely to receive beta-blockers or lipid-lowering therapy. Risk for death was higher during hospitalization and 30 days after discharge for patients with COPD than for those without (13.5% vs. 10.1% and 18.7% vs. 13.2%, respectively), and outcomes for patients with COPD did not improve over the study period. The authors found that COPD continued to have a negative effect on in-hospital and 30-day mortality rates (odds ratios, 1.25 and 1.31, respectively) after adjustment for multiple variables. However, they also found that use of evidence-based therapies increased in all patients with acute MI over the study period, especially use of beta-blockers and cardiac catheterization in those who also had COPD.
The authors acknowledged that their study did not include information on pulmonary function testing and so could not confirm COPD diagnoses or determine disease severity. However, they concluded that although use of guideline-recommended therapy improved in all acute MI patients and in patients with both acute MI and COPD from 1997 to 2007, differences in treatment persisted and the outcomes of patients with AMI and underlying COPD did not improve.
“The older age, higher number of comorbidities, and overlap between the respiratory and cardiac symptoms in patients with [acute] MI and COPD have important implications for management of these complex patients,” the authors wrote. “Physicians may consider patients with COPD at high risk for complications and they may be hesitant to recommend cardiac catheterization and PCI although these patients may equally benefit from the receipt of these more aggressive, but evidence-based interventions.”
The authors called for increased education for specialists and general internists to help improve assessment and management of cardiovascular risk at the time of COPD diagnosis. Clinicians should not “focus on the pulmonary disease in isolation,” they wrote. “Careful consideration is necessary to treat established cardiovascular risk factors and optimize cardiac therapies in patients with COPD.”