The impact of heart failure and chronic obstructive pulmonary disease on mortality in patients presenting with breathlessness

Abstract

Background Differentiating heart failure from chronic obstructive pulmonary disease (COPD) in a patient presenting with breathlessness is difficult but may have implications for outcome. We investigated the prognostic impact of diagnoses of COPD and/or heart failure in consecutive patients presenting to a secondary care clinic with breathlessness. Methods In patients with left ventricular systolic dysfunction (LVSD) by visual estimation, N-terminal pro B-type natriuretic peptide (NTproBNP) levels and spirometry were evaluated (N = 4986). Heart failure was defined as either LVSD worse than mild (heart failure with reduced ejection fraction) or LVSD mild or better and raised NTproBNP levels (> 400 ng/L) (heart failure with normal ejection fraction). COPD was defined as forced expiratory volume in 1 s (FEV 1 ) to forced vital capacity (FVC) ratio < 0.7. The primary outcome was all-cause mortality. Results 1764 (35%) patients had heart failure alone, 585 (12%) had COPD alone, 1751 (35%) had heart failure and COPD, and 886 (18%) had neither. Compared to patients with neither diagnosis, those with COPD alone [hazard ratio (HR) = 1.84 95% confidence interval (CI) 1.40-2.43], heart failure alone [HR = 4.40 (95% CI 3.54-5.46)] or heart failure and COPD ] had a greater risk of death. COPD was not associated with increased risk of death in patients with heart failure on a multivariable analysis. Conclusion While COPD is associated with increased risk of death compared to patients with neither heart failure nor COPD, it has a negligible impact on prognosis amongst patients with heart failure.

The impact of chronic obstructive pulmonary disease on hospitalization and mortality in patients with heart failure

“…Cuthbert et al enrolled a cohort of 4986 patients to a community heart failure clinic with suspected HF in the United Kingdom who underwent comprehensive evaluation by echocardiography, N-terminal pro-B-type natriuretic peptide, and spirometry, and found that COPD was only weakly but not independently associated with an increase in all-cause mortality in HFrEF patients, and not at all in those with HFpEF. 4 Consistently, our also suggested that COPD was associated with a significantly increased risk of all-cause mortality in HFrEF patients, but not in HFpEF patients. Of note, we only included two studies to pool the data of all-cause mortality for HFpEF patients.…”

“…29,30 Finally, a total of 18 studies (6 post hoc analyses of RCTs and 12 observational studies) were included in this meta-analysis. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The baseline characteristics of the included studies are shown in Table 1. Among them, 8 studies enrolled hospitalized HF patients, 9 studies enrolled chronic HF patients and 1 study 5 included both hospitalized HF and chronic HF patients.…”

Chronic Obstructive Pulmonary Disease and Heart Failure

“…"getting older" or "being unfit " COPD, whilst the prevalence of heart failure is perhaps 1-2%. Many reports suggest that a large proportion of breathlessness patients have both conditions (tables 2 26, 29-36 and 3 [37][38][39][40][41][42][43][44][45][46][47][48] ). It's worth noting that the diagnosis of "heart failure" includes those with either a reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction on imaging, which have a similar prevalence.…”

10.5937/mckg52-18735 - Systemic inflammation, systemic effects and comorbidities in chronic obstructive pulmonary disease

“…A significant correlation was found between the CTdetermined bone density of the thoracic spine CT of a specific lung emphysema, indicating the association of osteoporosis and emphysema. (4) copd and cardIovaScular dISorderS in patients with COPD, cardiovascular system disorders (CvD) can be due to the development of pulmonary hypertension and dysfunction of the chambers due to increased intrathoracic pressure as a result of hyperinflation of the lungs. Smoking represents a common risk factor for coronary artery disease, cardiac insufficiency and COPD and can contribute to the dysfunction of both organic systems.…”

“…Atherosclerotic plaques exhibit low-grade inflammation with an increased number of macrophages and secretion of iNF-c by Th1 lymphocytes, similar to the peripheral lungs of patients with COPD. (4)…”