Interplay between acute heart failure and COPD in patients hospitalized for dysponea: prognostic insights from the PARADISE cohort

INTRODUCTION: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are leading causes of acute dyspnoea in the emergency department (ED) and frequently coexist. However, their combined impact on short- and long-term outcomes in the acute setting remains insufficiently characterized. METHODS: We conducted a monocentric observational study based on the PARADISE cohort, including patients admitted to the ED for acute dyspnoea between 2010 and 2019. Patients with a primary diagnosis of HF or COPD were included and stratified according to the presence of the alternate condition. The primary outcomes were in-hospital and post-discharge all-cause mortality, assessed using multivariable regression models. RESULTS: Among 5131 patients, 3543 had a primary diagnosis of HF and 1588 of COPD. Concomitant disease was present in approximately 20% of patients in both groups.In the primary HF cohort, patients with COPD had lower in-hospital mortality compared with those without COPD (8.5% vs. 11.7%, P = .014), but similar overall mortality (69.3% vs. 68.9%). After adjustment, COPD remained associated with lower in-hospital mortality (OR 0.74; 95% CI 0.55-0.99; P = .050) and with a modest increase in long-term mortality (HR 1.22; 95% CI 1.09-1.36; P < .001).In the primary COPD cohort, patients with HF had higher in-hospital mortality (7.4% vs. 3.4%, P = .001) and markedly higher long-term mortality (68.7% vs. 48.7%, P < .001). After adjustment, HF was not significantly associated with in-hospital mortality (OR 1.54; 95% CI 0.87-2.65; P = .13), but remained strongly associated with increased long-term mortality (HR 1.48; 95% CI 1.25-1.76; P < .001). CONCLUSION: HF and COPD frequently coexist and are both associated with an increased long-term mortality risk, with a greater prognostic impact of HF in patients with COPD. These findings highlight the importance of systematic identification and optimized management of both conditions in this high-risk population.