Differences in Outcomes between Heart Failure Phenotypes in Patients with Coexistent Chronic Obstructive Pulmonary Disease: A Cohort Study

Gulea, Claudia; Zakeri, Rosita; Quint, Jennifer K

doi:10.1513/annalsats.202107-823oc

Cited by 12 publications

(3 citation statements)

References 55 publications

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“…Coexistent heart failure and COPD make the survival significantly shorter than for either disease alone [28]. Interestingly, the prognosis of patients with comorbid COPD and HFrEF is mainly determined by HFrEF, while in those with COPD and HFpEF, COPD dominates [29 ▪ ]. In PH associated with COPD, New York Heart Association functional class determined the overall prognosis [30].…”

Section: Clinical Impactmentioning

confidence: 99%

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Maeda,

Dransfield

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewChronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are both significant burdens on the healthcare system and often coexist. Mechanistic links between the two conditions and their clinical impact are increasingly understood.Recent findingsRecent studies demonstrate multiple mechanisms by which the pathobiology of COPD may have negative effects on the cardiovascular system. These include extrapulmonary consequences of the COPD inflammatory state, cardiac autonomic dysfunction, which has been recently implicated in worsening respiratory symptoms and exacerbation risk, and mechanical effects of lung hyperinflation on left ventricular diastolic function.Clinical studies have consistently shown a high prevalence of CVD in COPD patients and worsened outcomes (andvice versa). Exacerbations of COPD have also been demonstrated to dramatically increase the risk of cardiovascular events. While some safety concerns exist, medications for COPD and cardiovascular disease should be used in accordance with respective guidelines. However, real-world data show suboptimal management for patients with COPD and CVD.SummaryCOPD and cardiovascular disease have complicated interrelationships. Further mechanistic studies may lead to defining better targets for interventions. Education for medical professionals and implementation of novel screening protocols should be encouraged to fill in the gaps in clinical care for these patients.

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Section: Clinical Impactmentioning

confidence: 99%

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Maeda,

Dransfield

2023

Current Opinion in Pulmonary Medicine

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“…6 This is important because advanced age is associated with the concurrence of multiple co-morbid conditions, as well as deficits across multiple domains including cognition, physical function, and social environment. 2 While recent studies have demonstrated the prognostic importance of comorbid conditions, 7,8 cognitive impairment, 9 and frailty 10,11 in HFpEF, malnutrition may be an important geriatric condition 12,13 that is not well-studied.…”

Section: Introductionmentioning

confidence: 99%

Malnutrition in heart failure with preserved ejection fraction

Zainul,

Perry,

Pan

et al. 2023

J American Geriatrics Society

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BackgroundMalnutrition may be an important geriatric condition in adults with heart failure with preserved ejection fraction (HFpEF), but studies on its prevalence and associated clinical outcomes are limited. The aim of this study was to determine if malnutrition is associated with short‐term morbidity and mortality in ambulatory patients with HFpEF.MethodsWe examined 231 patients with a clinical diagnosis of HFpEF seen at two dedicated academic HFpEF programs (Weill Cornell Medicine and Michigan Medicine) from June 2018 to April 2022. Malnutrition was defined by Mini‐Nutritional Assessment Short Form (MNA‐SF) scores ≤11. The primary endpoint was a 6‐month composite of all‐cause mortality and all‐cause hospitalization. A Cox proportional‐hazard models was used to examine the association between malnutrition and the primary endpoint, adjusting for race, prior hospitalization history, and the validated Meta‐Analysis Global Group in Chronic (MAGGIC) heart failure prognostic risk score.ResultsThe median age of the cohort was 73 years (interquartile range 64–81). The most common comorbid conditions included hypertension (prevalence 81%), atrial fibrillation (43%), and obesity (63%). The prevalence of malnutrition was 42% (n = 97), and MNA‐SF scores did not significantly correlate with body mass index (R = −0.02, p = 0.71). At the 6‐month follow‐up, 62 patients (26.8%) were hospitalized and four patients died (1.7%). In a fully‐adjusted analysis, malnutrition was independently associated with the composite outcome of all‐cause mortality and all‐cause hospitalization (HR 1.94 [95% CI: 1.17–3.20], p = 0.01).ConclusionDespite a high prevalence of obesity, two out of five ambulatory adults with HFpEF are malnourished. Malnutrition was independently associated with adverse outcomes at 6 months. Future work is necessary to develop interventions that can address malnutrition.

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“…In this issue of AnnalsATS , Gulea and colleagues (pp. 971–980 ) report on a retrospective cohort study of insured patients in the United States with COPD and HF between 2008 and 2018 ( 3 ). The analysis examines differences among HF subtypes based on ejection fraction (EF): 1 ) HF with preserved EF (HFpEF, ⩾50%); 2 ) HF with mildly reduced EF (HFmrEF, 40–49%); and 3 ) HF with reduced EF (HFrEF, <40%).…”

mentioning

confidence: 99%

Comorbid Chronic Obstructive Pulmonary Disease and Heart Failure: Shared Risk Factors and Opportunities to Improve Outcomes

Khan

Kalhan

2022

Annals ATS

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Differences in Outcomes between Heart Failure Phenotypes in Patients with Coexistent Chronic Obstructive Pulmonary Disease: A Cohort Study

Cited by 12 publications

References 55 publications

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Malnutrition in heart failure with preserved ejection fraction

Comorbid Chronic Obstructive Pulmonary Disease and Heart Failure: Shared Risk Factors and Opportunities to Improve Outcomes

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