Impact of airflow limitation in chronic heart failure

Abstract

BackgroundComorbidities are common in chronic heart failure (HF) patients, but diagnoses are often not based on objective testing. Chronic obstructive pulmonary disease (COPD) is an important comorbidity and often neglected because of shared symptoms and risk factors. Precise prevalence and consequences are not well known. Therefore, we investigated prevalence, pulmonary treatment, symptoms and quality of life (QOL) of COPD in patients with chronic HF.Methods205 patients with stable HF for at least 1 month, aged above 50 years, were included from our outpatient cardiology clinic, irrespective of left ventricular ejection fraction. Patients performed post-bronchodilator spirometry, a six-minute walk test (6-MWT) and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). COPD was diagnosed according to GOLD criteria. Restrictive lung function was defined as FEV1/FVC ≥0.70 and FVC <80% of predicted value. The BODE and ADO index, risk scores in COPD patients, were calculated.ResultsAlmost 40% fulfilled the criteria of COPD and 7% had restrictive lung disease, the latter being excluded from further analysis. Noteworthy, 63% of the COPD patients were undiagnosed and 8% of those without COPD used inhalation therapy. Patients with COPD had more shortness of breath despite little difference in HF severity and similar other comorbidities. KCCQ was significantly worse in COPD patients. The ADO and BODE indices were significantly different.ConclusionCOPD is very common in unselected HF patients. It was often not diagnosed and many patients received treatment without being diagnosed with COPD. Presence of COPD worsens symptoms and negatively effects cardiac specific QOL.

Impact of non-cardiovascular comorbidities on the quality of life of patients with chronic heart failure: a scoping review

“…A negative and statistically significant relationship was found in most (61.5%, 8/13) of the studies between respiratory diseases, mainly chronic obstructive pulmonary disease (COPD), and HRQoL [8,16,18,28] (Fig. 4).…”

“…In addition, 7 of the 10 articles that indicated the etiology identified ischemic heart disease as the main cause of HF [18,30,32,34,36,37,40]. Additionally, 2 articles identified a high prevalence of ischemic heart disease (40% of the sample), although they did not indicate other possible origins [14,27].…”

“…Finally, from the 3 systematic reviews, 6 articles were selected that met the inclusion criteria. Finally, 21 articles were selected [8,[14][15][16][17][18][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Additional file 4 provides a list of included and excluded studies along with reasons for exclusion.…”

“…Different studies have observed that the non-cardiovascular comorbidities with the highest prevalence among patients with CHF include iron deficiency (prevalence of 53-65% [13]), anemia (prevalence of up to 37% [14]), diabetes mellitus (prevalence of between 23% [15] and 47% [16]), renal failure (prevalence of up to 55% [14]), depression (prevalence of up to 61% [17]), and respiratory diseases (prevalence of up to 63% [18]), among others. The presence of these comorbidities and their association with higher rates of hospitalization and length of hospitalization could lead to a significant deterioration in the functional capacity and health-related quality of life (HRQoL) of patients with CHF.…”

An old debate still in the β‐phase?

“…COPD is a common co‐morbidity in patients with chronic heart failure and contributes to morbidity and mortality . Similarly, chronic heart failure is frequently present in COPD patients, although often undiagnosed and untreated, and co‐morbid chronic heart failure has adverse effects in COPD .…”