Adequacy of Therapy for People with Both COPD and Heart Failure in the UK: Historical Cohort Study

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. The ageing of populations globally has brought attention to the issue of multimorbidity as a common concern and area for prioritization of research. In older individuals, COPD and heart failure (HF) often occur concomitantly, presenting diagnostic and therapeutic challenges for clinicians. However, published guidance on the treatment of comorbid COPD and HF is sparse, as consensus guidelines focus on the treatment of individual conditions. We used well-managed, longitudinal medical record databases in the UK to examine the demographic and clinical characteristics of patients prescribed adequate versus inadequate therapy within 3 months after newly diagnosed comorbid COPD or HF. We observed low levels of guidelines-recommended prescribing for therapy of new COPD and new HF diagnoses among patients with comorbid COPD and HF. Only one-For personal use only. third (30%) of patients in the HF-new COPD cohort were prescribed adequate COPD therapy within 3 months of the COPD diagnosis, and less than one-fifth (18%) of patients in the COPD-new HF cohort were prescribed adequate HF therapy within 3 months of the HF diagnosis. Patients most likely to be prescribed inadequate COPD therapy included women, current smokers, and non-obese patients, and those most likely to be prescribed inadequate HF therapy included current smokers and non-obese patients. Further work is needed to understand the reasons for under-prescribing and to address them. In addition, readily accessible clinical guidance is needed that addresses not only the diagnosis but the care of patients with comorbid COPD and HF. Finally, improved equity of access to integrated care for all patient subgroups with comorbid COPD and HF is needed, particularly for women, smokers, and non-obese patients.