Characteristics, treatments and 1‐year prognosis of hospitalized and ambulatory heart failure patients with chronic obstructive pulmonary disease in the European Society of Cardiology Heart Failure Long‐Term Registry

Abstract

Aims To describe the characteristics and assess the 1‐year outcomes of hospitalized (HHF) and chronic (CHF) heart failure patients with chronic obstructive pulmonary disease (COPD) enrolled in a large European registry between May 2011 and April 2013. Methods and results Overall, 1334/6920 (19.3%) HHF patients and 1322/9409 (14.1%) CHF patients were diagnosed with COPD. In both groups, patients with COPD were older, more frequently men, had a worse clinical presentation and a higher prevalence of co‐morbidities. In HHF, the increase in the use of heart failure (HF) medications at hospital discharge was greater in non‐COPD than in COPD for angiotensin‐converting enzyme inhibitors (+13.7% vs. +7.2%), beta‐blockers (+20.6% vs. +11.8%) and mineralocorticoid receptor antagonists (+20.9% vs. +17.3%), thus widening the gap in HF treatment already existing between the two groups at admission. In CHF patients, there was a similar increase in the use of these medications after enrollment visit in the two groups, leaving a significant difference of 8.2% for beta‐blockers in favour of non‐COPD patients (89.8% vs. 81.6%, P < 0.001). At 1‐year follow‐up, the hazard ratios for COPD in multivariable analysis confirmed its independent association with hospitalizations both in HHF [all‐cause: 1.16 (1.04–1.29), for HF: 1.22 (1.05–1.42)] and CHF patients [all‐cause: 1.26 (1.13–1.41), for HF: 1.37 (1.17–1.60)]. The association between COPD and all‐cause mortality was not confirmed in both groups after adjustments. Conclusions COPD frequently coexists in HHF and CHF, worsens the clinical course of the disease, and significantly impacts its therapeutic management and prognosis. The matter should deserve greater attention from the cardiology community.

When the Heart Steals Your Breath Away

“…This is in line with previous registries and clinical trials demonstrating COPD to be more strongly associated with CHF hospitalization than mortality [5, 6]. Hospitalizations could have been misclassified as worsening heart failure while in fact related to an acute exacerbation of COPD.…”

“…In line with this, renal dysfunction has previously been shown to be more common in CHF patients with COPD compared to CHF patients without COPD [6]. However, its independent prognostic value in COPD is a rather new finding.…”

Characteristics and long‐term prognosis of patients with heart failure and mid‐range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta‐analysis

“…Compared with HFpEF, the lower all‐cause mortality can be explained by the association of the markedly lower burden of co‐morbidities, younger age, and possibly excessive use of beta‐blockers and renin–angiotensin system blockers. Most likely, the worse renal function and higher prevalence of COPD contributed considerably to the poorer prognosis of HFpEF patients, despite the lower prevalence of IHD . The role of renal dysfunction as an independent predictor of mortality and the effect of its markedly high prevalence in HFpEF patients have been previously described and currently demonstrated in the Swedish registry .…”

It's time to move on from counting co‐morbidities to curing them: the case of chronic heart failure–chronic obstructive pulmonary disease co‐morbidity

“…The prevalence of the CHF–COPD co‐morbidity is reported as 10–20% in ambulatory heart failure (HF) studies vs. 20–30% or more in hospitalized HF studies . The finding of a higher prevalence of CHF–COPD in hospitalized patients than in the ambulatory population is recurrent in the literature.…”

“…The levels of other co‐morbidity were significantly higher (three‐ to six‐fold) in patients with coexisting HF and COPD compared with patients with either HF or COPD alone. In a recent large European HF registry conducted by the European Society of Cardiology (ESC) across 21 countries, including more than 16 000 patients collected by national networks of cardiology centres, 1334/6920 (19.3%) hospitalized HF patients and 1322/9409 (14.1%) ambulatory CHF patients were diagnosed with COPD . The CHF–COPD co‐morbidity seems, therefore, a significant public health issue in all settings explored.…”