Guideline directed medical therapy and mortality in COPD patients with heart failure, hospitalized for exacerbations

Optimal management of coexisting heart failure and COPD remains challenging, particularly during hospitalization for a COPD exacerbation. At ERS 2026 in Barcelona, Prof Dr Lies Lahousse, pharmacist and epidemiologist at Ghent University and Erasmus Medical Center, presented a poster examining real-world use and effectiveness of guideline-directed treatment in approximately 14,500 Belgian adults with heart failure hospitalized for a COPD exacerbation.

Only around 12% of patients received guideline-directed therapy for both conditions, defined in the study as at least a beta-blocker combined with an ACE inhibitor or angiotensin receptor blocker for heart failure, and LABA/LAMA therapy for COPD.

In-hospital mortality differed substantially according to treatment: it was 18% among patients receiving neither cardiovascular nor COPD guideline-directed therapy, compared with 8% among those receiving both. The analysis suggested additive associations, with cardiovascular and COPD guideline-directed therapies each associated with an approximately 40% reduction in in-hospital mortality. Following discharge, heart failure guideline-directed therapy, with or without COPD guideline-directed treatment, was also associated with a lower mortality risk.

These real-world findings highlight the low uptake of recommended therapies and support careful attention to guideline-directed management of both heart failure and COPD in this high-risk population.