Prevalence of airflow obstruction in patients with stable systolic heart failure

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is an important differential diagnosis in heart failure (HF). However, routine use of spirometry in outpatient HF clinics is not implemented. The aim of the present study was to determine the prevalence of both airflow obstruction and non obstructive lung function impairment in patients with HF and to examine the effect of optimal medical treatment for HF on lung function parameters.MethodsConsecutive patients with HF (ejection fraction (EF) < 45%) and New York Heart Association (NYHA) functional class II-IV at 10 different outpatient heart failure clinics were examined with spirometry at their first visit and after optimal medical treatment for HF was achieved. airflow obstruction was classified and graded according to the GOLD 2011 revision.ResultsBaseline spirometry was performed in 593 included patients and 71 (12%) had a clinical diagnosis of COPD. Mean age was 69 ± 11 years and mean EF was 30 ± 9%. Thirty-two % of the patients were active smokers and 53% were previous smokers. Mean FEV1 and FVC was 77.9 ± 1.7% and 85.4 ± 1.5% of predicted respectively. Obstructive pattern was observed in 233 (39%) of the patients. Of these, 53 patients (9%) had mild disease (GOLD I) and 180 (30%) patients had moderate to very severe disease (GOLD II-IV). No difference in spirometric variables was observed following up titration of medication.ConclusionIn stable patients with HF airflow obstruction is frequent and severely underdiagnosed. Spirometry should be considered in all patients with HF in order to improve diagnosis and treatment for concomitant pulmonary disease.

The prognostic significance of lung function in stable heart failure outpatients

“…Hence, the increased mortality with lower values in spirometry might be partly explained by lung congestion due to worsened cardiac performance. Despite an increase in medical therapy of patients included in this study, there was no increase in lung volumes . This could be explained by patients already being in a stable condition at baseline and in agreement with the lack of prognostic information the changes in FEV 1 or FVC divided by baseline FEV 1 or FVC for patients having a second spirometry.…”

“…Some eligible patients were not included in the present analyses. A full description of patients who did not perform a spirometry examination has been described in earlier publications; only minor differences from the included patients were found . There was a lack of follow‐up on mortality in 13 patients (2%), and we find this number acceptable as to not bias our results.…”

“…The changes in FEV 1 or FVC divided by baseline FEV 1 or FVC showed no significant associations to mortality in univariate Cox regression analyses. There was no difference in spirometry parameters before and after up‐titration of HF therapy, yet there was a > 50% reduction of severe dyspnea (NYHA class III–IV) …”

“…There was no difference in spirometry parameters before and after up-titration of HF therapy, yet there was a > 50% reduction of severe dyspnea (NYHA class III-IV). 8…”

“…All HF patients (New York Heart Association [NYHA] functional class II–IV and left ventricular ejection fraction [LVEF] <45%) referred to 10 outpatient HF clinics for medical optimization between January 1, 2009, and November 1, 2011, were offered a spirometry examination at the first visit to the HF clinic and at the last visit, where maximal possible doses of HF medication were achieved . Baseline demographic data, smoking history, and previous medical history were registered.…”