Mortalità a lungo termine di soggetti anziani affetti da insufficienza respiratoria ed insufficienza cardiaca cronica

Background: Chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD) are associated with high mortality in elderly subjects; concurrent CHF and COPD frequently occurs. This study examines long-term mortality in elderly subjects affected by CHF, COPD and coexistent CHF and COPD. Methods: The study evaluated mortality in 1288 subjects stratified for the presence or absence of CHF or COPD alone, and for coexistence of CHF and COPD over 12-year period. Results: Mortality, at 12 year follow-up, was 46.7% overall, 68.6% in the presence of CHF alone (p<0.001), 56.9% in the presence of COPD alone (p<0.01); mortality was 86.2% where CHF and COPD coexisted (p<0.001) and was significantly higher than in CHF or COPD alone (p<0.05). Multivariate analysis indicates that CHF (Hazard Risk=1.67, 95% Confidence Interval 1.15-3.27, p<0.031) and COPD (Hazard Risk=1.27, 95% Confidence Interval=1.08-1.85, p<0.042) were predictive of long-term mortality. When CHF and COPD simultaneously occurred, the risk dramatically increased up to 3.73 (95% Confidence Interval=1.19-6.93, p<0.001). Conclusions: Long-term follow up showed higher mortality amongst elderly subjects affected by CHF or COPD. Simultaneous presence of CHF and COPD significantly increased the risk of death. Therefore, the presence of COPD in CHF patients should be considered a relevant factor in predicting high risk of mortality.