Left-sided heart failure burden and mortality in idiopathic pulmonary fibrosis: a population-based study

Abstract

Background Cardiovascular disease is prevalent in idiopathic pulmonary fibrosis (IPF), yet the extent of left-sided heart failure (HF) burden, whether this has changed with time and whether HF impacts mortality risk in these patients are unknown. The aims of this study were therefore to determine the temporal trends in incidence and prevalence of left-sided HF in patients with IPF in England and compare these to published estimates in the general population and those with comparable chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), as well as determine the risk of all-cause and cause-specific mortality in patients with comorbid left-sided HF and IPF at population-level using electronic healthcare data. Methods Clinical Practice Research Datalink (CPRD) Aurum primary-care data linked to mortality and secondary-care data was used to identify IPF patients in England. Left-sided HF prevalence and incidence rates were calculated for each calendar year between 2010 and 2019, stratified by age and sex. Risk of all-cause, cardiovascular and IPF-specific mortality was calculated using multivariate Cox regression. Results From 40,577patients with an IPF code in CPRD Aurum, 25, 341 IPF patients met inclusion criteria. Left-sided HF prevalence decreased from 33.4% (95% CI 32.2–34.6) in 2010 to 20.9% (20.0–21.7) in 2019. Left-sided HF incidence rate per 100 person-years (95% CI) remained stable between 2010 and 2017 but decreased from 4.3 (3.9–4.8) in 2017 to 3.4 (3.0–3.9) in 2019. Throughout follow-up, prevalence and incidence were higher in men and with increasing age. Comorbid HF was associated with poorer survival (adjusted HR (95%CI) 1.08 (1.03–1.14) for all-cause mortality; 1.32 (1.09–1.59) for cardiovascular mortality). Conclusion Left-sided HF burden in IPF patients in England remains high, with incidence almost 4 times higher than in COPD, a comparable lung disease with similar cardiovascular risk factors. Comorbid left-sided HF is also a poor prognostic marker. More substantial reduction in left-sided HF prevalence than incidence suggests persistently high IPF mortality. Given rising IPF incidence in the UK, this calls for better management of comorbidities such as left-sided HF to help optimise IPF survival.

Clinical Characterization and Predictive Factors for Progression in a Cohort of Patients with Interstitial Lung Disease and Features of Autoimmunity: The Need for a Revision of IPAF Classification Criteria

“…Statins may cause ILD as a side effect, while moderate/severe OSAS could lead to subclinical ILD through alveolar epithelial injury and extracellular matrix remodeling [68,69]. Finally, recent evidence showed that IPF patients had an incidence of left-sided heart failure almost four times higher than COPD, a lung disease with similar risk factors [70]. Further studies are needed to confirm these data in IPAF patients.…”

Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease

“…Asthma is the second most prevalent chronic respiratory disease and has also been associated with an increased risk of cardiovascular disease, including MI, HF, angina, and stroke (9, 10, 11). Interstitial lung diseases, including pulmonary fibrosis, have been associated with an increased risk of HF, MI, and IHD(12, 13). Similarly, studies have reported that the risk of stroke and IHD is higher in people with bronchiectasis compared with the general population (14).…”