Three-year hospitalization and mortality in elderly smokers with COPD or CHF.

Background: In elderly smokers, COPD and CHF usually present with dyspnoea. COPD and CHF are associated almost invariably with concomitant chronic diseases which contribute to severity and prognosis. Objectives: We investigated similarities and differences in the clinical presentation, concomitant chronic diseases and risk factors for mortality and hospitalization at 3-year follow-up in elderly smokers/ex-smokers with a primary diagnosis of COPD or CHF recruited and followed in specialized centers. Methods: We examined 144 patients with COPD and 96 with CHF, ≥ 65 yrs, ≥20 pack/years, and measured CAT score, mMRC, NYHA, and Charlson Index, routine blood test, eGFR, HRCTscan, 6MWT. In addition, in each patient we actively searched for CHF, COPD, peripheral vascular disease, and metabolic syndrome. Results: COPD and CHF patients had mild to moderate disease, but the majority was symptomatic. Comorbidities were highly prevalent and often unrecognized in both groups. COPD and CHF patients had a similar risk of hospitalization and death at 3 years. Lower glomerular filtration rate, shorter 6MWT and ascending aorta calcification score ≥2 were independent predictors of mortality in COPD, whereas previous 12 month hospitalizations, renal disease and heart diameter were in CHF patients. Lower glomerular filtration rate value, higher CAT score and lower FEV1/FVC ratio were associated with hospitalization in COPD, whilst age, lower FEV1 % predicted and peripheral vascular disease were in CHF. Conclusions: There are relevant similarities and differences between patients with COPD and CHF even when admitted to specialized outpatient centers, suggesting that these patients should be manage in multidisciplinary units.