Misclassification of Both Chronic Obstructive Pulmonary Disease and Heart Failure

Rutten, Frans H.; Broekhuizen, Berna D L

doi:10.1001/jamanetworkopen.2018.5486

Cited by 9 publications

(8 citation statements)

References 12 publications

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“…The use of a fixed FEV 1 /FVC ratio of 0.7 as criterion for COPD in the Danish study, instead of LLN, which we used, has probably also contributed to a higher prevalence of COPD 24 . Several authors have warned against overdiagnosis of COPD in HF, because pulmonary congestion can lead to bronchial obstruction and a decreased FEV 1 /FVC ratio 5,26,27 . The strict criteria for COPD in our study (FEV 1 /FVC < LLN and symptoms) have probably made overdiagnosis less likely.…”

Section: Discussionmentioning

confidence: 85%

“…24 Several authors have warned against overdiagnosis of COPD in HF, because pulmonary congestion can lead to bronchial obstruction and a decreased FEV 1 /FVC ratio. 5,26,27 The strict criteria for COPD in our study (FEV 1 /FVC < LLN and symptoms) have probably made overdiagnosis less likely. The high frequency of coughing, smoking, FEV 1 < LLN, and self-reported COPD in the group with both diseases compared with those with HF only (Table 1) indicates that overdiagnosis of COPD in subjects with HF has been a minor problem.…”

Section: Comparison With Previous Studiesmentioning

confidence: 78%

“…2,4 Heart failure and COPD might be underdiagnosed at an early stage partly due to unspecific early symptoms. 5 A cardinal symptom for HF, exertional dyspnoea, 6 is also shared by COPD, and also, cough may be present in both diseases. 7 HF and COPD may overlap and increasingly by age.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of chronic heart failure and chronic obstructive pulmonary disease in a general population: the Tromsø study

et al. 2020

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Aims Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are main causes of dyspnoea, and echocardiography and spirometry are essential investigations for these diagnoses. Our aim was to determine the prevalence of HF and COPD in a general population, also how the diseases may be identified, and to what extent their clinical characteristics differ. Methods and results In the seventh survey of Tromsø study (2015-16), subjects aged 40 years or more were examined with echocardiography, spirometry, lung sound recordings, questionnaires, including the modified Medical Research Council (mMRC) questionnaire on dyspnoea, and N-terminal pro-brain natriuretic peptide analysis. A diagnosis of HF (HF with reduced ejection fraction, HF with mid-range ejection fraction, or HF with preserved ejection fraction) or COPD was established according to current guidelines. Predictors of HF and COPD were evaluated by logistic regression and receiver operating characteristic curve analysis. A total of 7110 participants could be evaluated for COPD, 1624 for HF, and 1538 for both diseases. Age-standardized prevalence of HF was 6.8% for women and 6.1% for men; the respective figures for COPD were 5.2% and 5.1%. Among the 1538 evaluated for both diseases, 139 subjects fulfilled the HF criteria, but only 17.1% reported to have the disease. Of those fulfilling the COPD criteria, 31.6% reported to have the disease. Shortness of breath at exertion was a frequent finding in HF; 59% of those with mMRC ≥2 had HF, while such shortness of breath was found in 24% among those with COPD. Reporting mMRC ≥2 had an odds ratio for HF of 19.5 (95% confidence interval 11.3-33.7), whereas the odds ratio for COPD was 6.3 (95% confidence interval 3.5-11.6). Current smoking was the strongest predictor of COPD but did not predict HF. Basal inspiratory crackles were significant predictors of HF in multivariable analysis. Among the subtypes of HF, an age <70 years was most frequently found in HF with reduced ejection fraction, in 51.7%. Clinical scores based on the predictive value in multivariable analysis of history, symptoms, and signs predicted HF and COPD with areas under the curve of 0.833 and 0.829, respectively. Conclusions Study participants with HF and COPD were in most cases not aware of their condition. In general practice, when an elderly patient present with shortness of breath, both diseases should be considered. Previous cardiovascular disease points at HF, while a history of smoking points at COPD. The threshold should be low for ordering echocardiography or spirometry for verifying the suspected cause of dyspnoea.

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Section: Discussionmentioning

confidence: 85%

Section: Comparison With Previous Studiesmentioning

confidence: 78%

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Prediction of chronic heart failure and chronic obstructive pulmonary disease in a general population: the Tromsø study

et al. 2020

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“…Several limitations are also noteworthy. The diagnosis of COPD is subject to misclassification due to the overlap of symptoms and signs with HF, along with spirometric obstruction in patients with pulmonary congestion 31,32 . The cohort definition required at least one annual contact to enable assessment of visit reason and medications.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and treatment of heart failure with chronic obstructive pulmonary disease in Canadian primary care

Hawkins,

Peterson,

Salimian

et al. 2023

ESC Heart Failure

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AimsHeart failure (HF) and chronic obstructive pulmonary disease (COPD) are largely managed in primary care, but their intersection in terms of disease burden, healthcare utilization, and treatment is ill‐defined.Methods and resultsWe examined a retrospective cohort including all patients with HF or COPD in the Canadian Primary Care Sentinel Surveillance Network from 2010 to 2018. The population size in 2018 with HF, COPD, and HF with COPD was 15 778, 27 927, and 4768 patients, respectively. While disease incidence declined, age–sex‐standardized prevalence per 100 population increased for HF alone from 2.33 to 3.63, COPD alone from 3.44 to 5.96, and COPD with HF from 12.70 to 15.67. Annual visit rates were high and stable around 8 for COPD alone but declined significantly over time for HF alone (9.3–8.1, P = 0.04) or for patients with both conditions (14.3–11.9, P = 0.006). For HF alone, cardiovascular visits were common (29.4%), while respiratory visits were infrequent (3.5%), with the majority of visits being non‐cardiorespiratory. For COPD alone, respiratory and cardiovascular visits were common (16.4% and 11.3%) and the majority were again non‐cardiorespiratory. For concurrent disease, 39.0% of visits were cardiorespiratory. The commonest non‐cardiorespiratory visit reasons were non‐specific symptoms or signs, endocrine, musculoskeletal, and mental health. In patients with HF with and without COPD, angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor–neprilysin inhibitor use was similar, while mineralocorticoid receptor antagonist use was marginally higher with concurrent COPD. Beta‐blocker use was initially lower with concurrent COPD compared with HF alone (69.3% vs. 74.0%), but this progressively declined by 2018 (74.5% vs. 73.5%).ConclusionsThe prevalence of HF and COPD continues to rise. Although patients with either or both conditions are high utilizers of primary care, the majority of visits relate to non‐cardiorespiratory comorbidities. Medical therapy for HF was similar and the initially lower beta‐blocker utilization disappeared over time.

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“…Univariate and multivariate Cox proportional hazards models, adjusted for age, sex, and duration of disease were used to determine the association between socio-geographic factors and death. Patients diagnosed with HF until 1 January 2016 and alive at this date were followed until death or 31…”

Section: Data Analysesmentioning

confidence: 99%

Determinants of survival in patients with chronic heart failure: a population‐based study in Reggio Emilia, Italy

Pedroni,

Djuric,

Mancuso

et al. 2023

ESC Heart Failure

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AimsWe aim to monitor and improve the quality of the heart failure (HF) integrated assistance model defined by national and regional guidelines and implemented in the province of Reggio Emilia, Italy. Specific aims of the audit were to estimate the prevalence of HF, describe the characteristics of patients with HF and the rate of patients enrolled in the integrated care treated in primary care, and identify socioeconomic and geographic determinants of the 4‐year survival of these patients.Methods and resultsRetrospective analysis of a cohort of prevalent cases of HF, diagnosed before 31 December 2015 in Reggio Emilia, Italy, alive on 1 January 2016, and residing at the time of diagnosis on the provincial territory. Age and sex‐adjusted prevalence of HF by area of residence were calculated according to the standard European population 2013. Patients were followed until death or 31 December 2019, whatever came first. The outcome measure of the study was four‐year case fatality. Cox proportional hazards models, adjusted for age, sex, and duration of disease were used to determine the association between socio‐geographic factors and death. The 4‐year case‐fatality rate was 36.7%, and it was the highest in the mountains (50.8%) compared with hills (34.6%), lowland (35.4%) and city (37.7%). The prevalence of HF was the lowest in the mountain [149.9, 95% confidence interval (CI) 112.1–187.7] and the highest in the lowland (340.8, 95% CI 308.7–372.9) and city (308, 95% CI 276.0–321.2). Patients living in the mountains had a lower deprivation index, and fewer hospitalizations prior to official diagnosis, although these characteristics were not statistically significant determinants of HF death in multivariate analysis. Behavioural (smoking and obesity) and socio‐geographic characteristics (educational level, deprivation index and area of residence) were not significantly associated with mortality in both univariable and multivariable analysis; however, patients who live in mountains (hazard ratio 1.10, 95% CI 0.73–1.66) or hills (hazard ratio 1.11, 95% CI 0.90–1.37) had a slightly higher risk of death than those living in the city. Only 197 (12.1%) of patients in the cohort were enrolled in the integrated care pathway over the course of 4 years.ConclusionsAlthough clinical determinants outweigh the geographic and behavioural disparities in the survival of patients with CHF treated in primary care, effective prevention strategies are needed to address environmental and socio‐geographic inequalities in access to primary care and to hasten equitable linkage to integrated care.

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Misclassification of Both Chronic Obstructive Pulmonary Disease and Heart Failure

Abstract: Both heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common in the elderly population and are at least partly understood as accelerated aging. They share smoking and systemic

Cited by 9 publications

References 12 publications

Prediction of chronic heart failure and chronic obstructive pulmonary disease in a general population: the Tromsø study

Prediction of chronic heart failure and chronic obstructive pulmonary disease in a general population: the Tromsø study

Epidemiology and treatment of heart failure with chronic obstructive pulmonary disease in Canadian primary care

Determinants of survival in patients with chronic heart failure: a population‐based study in Reggio Emilia, Italy

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