Research Paper|Volume 11, Issue 11|pp 3650—3667

Real-world effectiveness of medications on survival in patients with COPD-heart failure overlap

Vincent Yi-Fong Su^1,^3,⁴, Yao-Hsu Yang^8,^9,^10,¹², Diahn-Warng Perng^2,³, Ying-Huang Tsai^7,¹¹, Kun-Ta Chou^2,^3,⁴, Kang-Cheng Su^2,³, Wei-Juin Su^2,³, Pau-Chung Chen¹³, Kuang-Yao Yang^2,^3,^5,⁶

¹Department of Internal Medicine, Taipei City Hospital, Taipei City Government, Taipei, Taiwan
²Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
³Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
⁴Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
⁵Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
⁶Cancer Progression Research Center, National Yang-Ming University, Taipei, Taiwan
⁷Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan
⁸Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
⁹Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
¹⁰School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
¹¹Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
¹²Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
¹³Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

* Equal contribution

Received: March 6, 2019Accepted: May 27, 2019Published: June 7, 2019

https://doi.org/10.18632/aging.102004

Copyright: Su et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The appropriate treatment for patients with coexistent chronic obstructive pulmonary disease (COPD) and heart failure (HF) remains unclear. Data from the Taiwan National Health Insurance Research Database was used for this retrospective cohort study. Patients diagnosed with both diseases between 1997 and 2012 were enrolled as the COPD-heart failure overlap cohort. Patients were categorized as non-users and users of specific COPD and HF medications. Medication prescriptions in each 3-month and 1-year period served as time-dependent covariates. The primary endpoint was cumulative survival. The validation study confirmed the accuracy of definitions of COPD (94.0% sensitivity) and HF (96.3% sensitivity).The study included 275,436 patients with COPD-heart failure overlap, with a mean follow-up period of 9.32 years. The COPD-heart failure overlap cohort had more medical service use and higher mortality than did the COPD alone cohort. Use of inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) combinations, long-acting muscarinic antagonist (LAMA), angiotensin receptor blockers (ARBs), β blockers, aldosterone antagonists, and statins reduced mortality risk compared with non-use. Sensitivity and subgroup analyses confirmed the consistency and robustness of results.

ICS/LABA combinations, LAMA, ARBs, β blockers, aldosterone antagonists, and statins use was associated with a lower mortality risk in patients with COPD-heart failure overlap.