Guideline-directed medical therapy and mortality in heart failure patients hospitalized for COPD exacerbation

RATIONALE: Real-world effectiveness of cardiovascular and LABA/LAMA treatment in patients with heart failure (HF) during hospitalized exacerbation of COPD (ECOPD) is limited. OBJECTIVES: To investigate associations of guideline-directed medical therapy (GDMT) during hospitalization with in-hospital and post-discharge all-cause mortality and readmission risk. METHODS: HF patients aged ≥18 years hospitalized for ECOPD were included in this Belgian nationwide observational cohort between 2017-2022. HF GDMT was defined as use of at least beta-blockers in combination with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors following 2016 ESC guidelines, whereas COPD GDMT was defined as use of at least LABA+LAMA following 2017 GOLD report. Multivariable adjusted logistic regression and time-to-event analyses were used to investigate the associations. MAIN RESULTS: Among 14,582 patients (mean age 76.8 years, 40.7% females), GDMT was dispensed for HF only (20.4%), COPD only (23.6%) or both HF and COPD (11.9%). During hospitalization, 14.1% (2,058/14,582) died: 18.1% (no GDMT), 11.1% (HF GDMT), 11.0% (COPD GDMT) and 7.9% (both GDMT), respectively. HF GDMT was significantly associated with a 38% lower in-hospital mortality odds (aOR 0.62, 95%CI 0.55-0.70), while COPD GDMT was independently associated with a 40% lower odds (aOR 0.60, 95%CI 0.53-0.67). HF GDMT, alone (aHR 0.83, 95%CI 0.77-0.88) or combined with COPD GDMT (aHR 0.82, 95%CI 0.75-0.89), was associated with a significantly lower post-discharge mortality risk, whereas no significant associations between GDMT and readmission were observed. CONCLUSIONS: These results highlight the importance of HF GDMT, alongside optimised COPD management during hospitalization, to reduce in-hospital and post-discharge mortality risk.