Prevalence and Prognostic Impact of Chronic Obstructive Pulmonary Disease in Patients with Chronic Heart Failure: Data from the GISSI-HF Trial

Abstract

Objectives: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure (HF). We aimed to assess its prevalence, characterization and long-term prognostic impact in the GISSI-HF population. Methods: The study randomized 6,975 ambulatory HF patients to either n-3 polyunsaturated fatty acids or placebo. We performed a retrospective analysis of clinical characteristics and outcomes of the 1,533 patients diagnosed with COPD (22%). Results: COPD was associated with a worse clinical presentation and an increased burden of comorbidities. At a median follow-up of 3.9 years, COPD was found to be an independent predictor of both predefined primary study end points, including all-cause mortality (HR 1.28, 95% CI 1.15-1.43, p < 0.0001) and all-cause mortality or hospitalization for cardiovascular reasons (HR 1.19, 95% CI 1.10-1.30, p < 0.0001). Both cardiovascular (HR 1.20, 95% CI 1.05-1.36, p = 0.007) and noncardiovascular mortality (HR 1.56, 95% CI 1.26-1.94, p < 0.0001) were significantly increased in COPD-HF patients, as well as hospitalizations for any reason (HR 1.23, 95% CI 1.14-1.34, p < 0.0001), for cardiovascular reasons (HR 1.16, 95% CI 1.06-1.27, p = 0.002) and for HF (HR 1.27, 95% CI 1.14-1.43, p < 0.0001). Conclusions: COPD is an independent predictor of mortality and hospitalizations in ambulatory HF patients. Increased awareness and improved management of COPD may reduce the burden of this morbidity to patients with HF.

Characteristics, treatments and 1‐year prognosis of hospitalized and ambulatory heart failure patients with chronic obstructive pulmonary disease in the European Society of Cardiology Heart Failure Long‐Term Registry

“…The finding of a higher prevalence of COPD in the HHF than in the CHF population (19.3% vs. 14.1% in the present analysis) is recurrent in the literature, with a prevalence of ∼10–20% in ambulatory HF studies vs. 20–30% in HHF studies . This is likely due, at least in part, to some diagnostic overestimation in the acute HF setting, when signs and symptoms of COPD may be more easily misinterpreted and a confirmatory spirometric evaluation being less frequently performed.…”

“…Chronic obstructive pulmonary disease (COPD) is a common co‐morbidity that worsens the clinical course of heart failure (HF), both in the acute and chronic phases of the disease . Several publications to date have investigated the prevalence of COPD in HF 2 and its impact on HF clinical presentation, treatment and outcomes . Some contrasting findings have been reported, primarily due to the design of the study (i.e.…”

“…months vs. years) and the outcomes considered (i.e. hospitalizations and mortality for cardiovascular and non‐cardiovascular reasons) . More importantly, the majority of the data were from populations enrolled 10 or more years ago, when the importance of neurohormonal inhibition of the sympathetic nervous and renin–angiotensin–aldosterone systems in HF was less recognized.…”

Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge

“…Some co‐morbidities including chronic obstructive pulmonary disease and diabetes are common among the HF population, but can be effectively treated if recognized . Depression should not be neglected not only because it may impair quality of life and may lead to non‐adherence to HF therapy, but also because it may result in the loss of motivations to cope with cancer diagnosis and treatment.…”

Lung diffusion capacity in advanced heart failure: relation to central haemodynamics and outcome

“…3 The co-existence of COPD and HF is often a therapeutic and diagnostic challenge in HF management, 4 and COPD in patients with HF is associated with a worse clinical status and an increased risk of cardiovascular death and hospitalizations. 5 HF-related changes in pulmonary function are likely multifactorial and explained by interstitial and/or alveolar oedema, increased heart size leading to lung tissue displacement, pulmonary vascular remodelling, and respiratory muscle weakness. [6][7][8][9] It is well known that patients with congestive HF (CHF) have a reduction in pulmonary diffusion capacity for carbon monoxide (D LCO ), 1 and CHF is known to increase the resistance to gas transfer across the alveolarcapillary membrane.…”