Morbidity and mortality in a population of patients affected by heart failure and chronic obstructive pulmonary disease: an observational study

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) and heart failure (HF) often coexist. Moreover, elderly patients suffering from HF have a higher incidence of COPD, which further complicates their clinical condition. Indacaterol/glycopirronium has shown benefits in the treatment of COPD, with few cardiologic adverse effects. We evaluated the safety and efficacy of this therapy in patients with history of HF.MethodsWe enrolled 56 patients with a history of HF (New York Heart Association [NYHA] classes II and III) and stable COPD. We evaluated blood samples, clinical assessment, echocardiograms and basal spirometry at baseline and after 6 months of therapy with indacaterol/glycopirronium. In addition, the number of re-hospitalizations during the treatment period was evaluated.ResultsThe treatment was well tolerated. Brain natriuretic peptide (BNP) levels were significantly reduced compared with baseline (p < 0.001) after 6 months of treatment, and a higher percentage of patients improved their clinical status compared with baseline (p < 0.001). Minor changes were noted in the hemodynamic and metabolic parameters. Significant improvements in the echocardiographic parameters were noted in HF with reduced ejection fraction (HFrEF) patients. All respiratory parameters (forced expiratory volume in 1 s [FEV1], FEV1/forced vital capacity [FVC] ratio and COPD Assessment Test [CAT] scores) improved significantly (p < 0.001). No hospitalizations owing to HF or COPD exacerbation occurred. One patient died of respiratory failure.ConclusionIndacaterol/glycopirronium was well-tolerated and effective in the treatment of COPD in this cohort of patients with a history of HF. Further studies are needed to clarify whether this compound can have a direct role in improving overall cardiovascular function.

Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department

“…The strong association of underlying cardiovascular comorbidities in any degree of COPD severity suggests that ED management should always include a workup for potential associated cardiovascular events. A high degree of suspicion, past history of cardiovascular diseases, ECG and NT-proBNP, a valuable tool in the diagnosis of HF, are recommended steps to reach a diagnosis of HF, yet it will still be difficult in the presence of COPD [13,24]. In our cohort, the results of NT-proBNP and CRP done during the RW admission, where heart failure was confirmed by the echocardiogram, were similar to the ones done in the ED.…”

“…As part of the multimorbid condition associated with age and smoking, COPD is often associated with cardiac and other comorbidities [7][8][9]. Cardiovascular disease can be found in about 20% of patients with COPD, and due to the similarity of their clinical presentation, could be extremely difficult to diagnose [1,10,11,13,14].…”

A randomized controlled trial of long-acting muscarinic antagonist and long-acting β2 agonist fixed-dose combinations in patients with chronic obstructive pulmonary disease

“…According to recent reports, LAMA/LABA combination therapy may improve left ventricular end-diastolic volume, possibly by improving lung hyperinflation [ 27 ]. Moreover, LAMA/LABA combination therapy may improve cardiac function in COPD patients with heart failure [ 28 ].…”

Recent Advances in β2-Agonists for Treatment of Chronic Respiratory Diseases and Heart Failure

“…Unexpectedly, LABA/LAMA combinations have been found to be associated with a slightly higher cardiovascular risk as compared with LABAs alone and LAMAs alone which showed similar risks. 263 In a more recent cohort study of COPD patients with a history of HF, 264 the use of indacaterol (4)/glycopirronium, an ultra-LABA/LAMA combination, was associated with beneficial cardiovascular outcomes.…”