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Background: Multiple morbidity is the norm in advanced COPD and contributes to high symptom burden and worse outcomes., Research Question: Can distinct comorbidity profiles be identified and validated in a community-based sample of patients with COPD from a large integrated health care system using a standard, commonly used diagnostic code-based comorbidity index and downstream 2-year health care use data?, Study Design and Methods: In this retrospective cohort study, we used latent class analysis (LCA) to identify comorbidity profiles in a population-based sample of 91,453 patients with a COPD diagnosis between 2011 and 2015. We included specific comorbid conditions from the Charlson Comorbidity Index (CCI) and accounted for variation in underlying prevalence of different comorbidities across the three study sites. Sociodemographic, clinical, and health-care use data were obtained from electronic health records (EHRs). Multivariate logistic regression analysis was used to compare rates of acute and postacute care use by class., Results: The mean age was 71 ± 11 years, 55% of patients were women, 23% of patients were people of color, and 80% of patients were former or current smokers. LCA identified four distinct comorbidity profiles with progressively higher CCI scores: low morbidity (61%; 1.9 ± 1.4), metabolic renal (21%; 4.7 ± 1.8), cardiovascular (12%; 4.6 ± 1.9), and multimorbidity (7%; 7.5 ± 1.7). In multivariate models, during 2 years of follow-up, a significant, nonoverlapping increase was found in the odds of having any all-cause acute (hospitalizations, observation stays, and ED visits) and postacute care use across the comorbidity profiles., Interpretation: Distinct comorbidity profiles can be identified in patients with COPD using standard EHR-based diagnostic codes, and these profiles are associated with subsequent acute and postacute care use. Population-based risk stratification schemes for end-to-end, comprehensive COPD management should consider integrating comorbidity profiles such as those found in this study., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Introduction: The Kaiser Permanente ASCVD Risk Estimator (KPARE) was developed to address the systematic overestimation of actual ASCVD risk by the ACC/AHA ASCVD Pooled Cohort Equation (ACC/AHA PCE) in contemporary populations. We evaluated the accuracy and generalizability of KPARE for estimating 10-year ASCVD risk in eligible primary prevention, community-based populations in the U.S. and Canada, as compared with the ACC/AHA PCE. Methods: We identified adults 40-79 years old in 3 contemporary U.S. populations (Kaiser Permanente Northern California (KPNC), Southern California (KPSC) and Northwest (KPNW), as well as adults 66-79 years old in Ontario, Canada who had LDL-C 70-189 mg/dL, no known ASCVD, diabetes or lipid-lowering therapy and had complete follow-up. Non-fatal and fatal ASCVD events were ascertained from health system electronic health records and death certificates using validated algorithms. We examined observed ASCVD event rates within deciles of predicted 10-year risk using the KPARE vs. the ACC/AHA PCE predicted risk, and calculated metrics of discrimination and calibration. Results: In eligible primary prevention validation cohorts of KPNC (N=151,409), KPSC (N=246,815), KPNW (N=46,784), and Ontario, Canada (N=60,612 adults), the KPARE showed both better discrimination and calibration (Figure) compared to the ACC/AHA PCE to predict 10-year risk of ASCVD events, with c-statistics of 0.78, 0.78, 0.79, and 0.65, respectively. Categorical net reclassification index showed the KPARE improved ASCVD risk prediction over the ACC/AHA PCE by 23% in the KPNC validation cohort, 24% in KPSC, 33% in KPNW, and 25% in Ontario, Canada. Results were similar when stratified by race-gender subgroups. Conclusions: The new Kaiser Permanente ASCVD Risk Estimator provides more accurate ASCVD risk estimates in various community populations than the ACC/AHA PCE and may provide greater utility in shared decision-making for primary prevention strategies. [ABSTRACT FROM AUTHOR]

Low transferrin saturation (TSAT) or reduced serum ferritin level are suggestive of iron deficiency but the relationship between iron parameters and outcomes has not been systematically evaluated in older adults with heart failure (HF) and anemia. We identified a multicenter cohort of adults age ≥ 65 years with HF and incident anemia (hemoglobin <13 g/dL [men] or < 12 g/dL [women]) between 2005 and 2012. Patients were included if ferritin (ng/mL) and TSAT (%) were evaluated within 90 days of incident anemia. HF hospitalizations and all-cause death were ascertained from electronic health records. Among 4103 older adults with HF and incident anemia, 47% had TSAT <20% and the median (IQR) ferritin was 126 (53, 256) ng/mL. In multivariable analyses, compared with TSAT ≥20%, patients with TSAT <20% were at increased risk of HF hospitalization for serum ferritin <100 ng/mL (adjusted HR [aHR] 1.40, 95% CI:1.16–1.70) and 100–300 ng/mL (aHR 1.24, 95% CI:1.01–1.52) but not for a ferritin >300 ng/mL (aHR 0.89, 95% CI 0.65–1.23). In addition, TSAT <20% was independently associated with an increased risk of all-cause death regardless of serum ferritin level (<100 ng/mL: aHR 1.42, 95% CI:1.20–1.68; 100–300 ng/mL: aHR 1.18, 95% CI:1.00–1.38; >300 ng/mL: aHR 1.33, 95% CI:1.06–1.69). Among older adults with HF and incident anemia who had iron studies tested, nearly half had a TSAT <20%, which was independently associated with higher rates of morbidity and death. • Among older adults with HF, ~55% of patients were found to have iron deficiency (i.e., ferritin <100 ng/mL or ferritin 100–300 ng/mL and TSAT <20%). • A TSAT <20% was independently associated with HF hospitalizations and all-cause death. • These findings remained unchanged in sensitivity analyses stratified by degree of systolic dysfunction (i.e., reduced vs. mid-range vs. preserved). [ABSTRACT FROM AUTHOR]