Undiagnosed airflow limitation in patients at cardiovascular risk

Bérard, Emilie; Bongard, Vanina; Roche, N.; Pérez, Thierry; Brouquières, Dany; Fievez, S.; Denis, F.; Escamilla, R.; Ferrières, Jean

doi:10.1016/j.acvd.2011.10.002

Cited by 10 publications

(2 citation statements)

References 40 publications

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“… 26 – 30 The inverse situation – an increase in the risk of COPD in patients with a history of cardiovascular disease – has been shown in other studies. 14 , 31 , 32 The worsened prognosis for patients with IHD and COPD together has been demonstrated in various studies carried out in patients with IHD who have undergone PCI. 3 – 5 , 9 , 11 , 12 Other studies have shown a worse prognosis for patients with COPD and acute myocardial infarction, revealing greater risk of heart failure, bleeding, cardiogenic shock, and mortality.…”

Section: Discussionmentioning

confidence: 97%

Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study

Almagro¹,

Lapuente²,

Pareja³

et al. 2015

COPD

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BackgroundRetrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD – previously or newly diagnosed – in patients with IHD treated with PCI.MethodsPatients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed.ResultsA total of 133 patients (78%) male, with a mean (SD) age of 63 (10.12) years were included. Of these, 33 (24.8%) met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%–75%]: 546–1,160). COPD patients had greater mortality (P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76–44.47) and number of cardiovascular events (P=0.024; HR: 1.87; 95% CI: 1.04–3.33), even those without a previous diagnosis of COPD (P=0.01; HR: 1.78; 95% CI: 1.12–2.83). These differences remained after adjustment for sex, age, number of coronary vessels affected, and previous myocardial infarction (P=0.025; HR: 1.83; 95% CI: 1.08–3.1).ConclusionPrevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients have an independent greater mortality and a higher number of cardiovascular events during follow-up.

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Section: Discussionmentioning

confidence: 97%

Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study

Almagro¹,

Lapuente²,

Pareja³

et al. 2015

COPD

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“…Not only do the two diseases share major symptoms such as dyspnoea and fatigue, they also have common etiological factors such as smoking and ageing [5–8]. Consequently, under- and over-diagnosing COPD in HF patients are common [9–12]. Also from a therapeutic and prognostic perspective, the coincidence of COPD and HF is relevant.…”

Section: Introductionmentioning

confidence: 99%

Impact of airflow limitation in chronic heart failure

et al. 2017

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BackgroundComorbidities are common in chronic heart failure (HF) patients, but diagnoses are often not based on objective testing. Chronic obstructive pulmonary disease (COPD) is an important comorbidity and often neglected because of shared symptoms and risk factors. Precise prevalence and consequences are not well known. Therefore, we investigated prevalence, pulmonary treatment, symptoms and quality of life (QOL) of COPD in patients with chronic HF.Methods205 patients with stable HF for at least 1 month, aged above 50 years, were included from our outpatient cardiology clinic, irrespective of left ventricular ejection fraction. Patients performed post-bronchodilator spirometry, a six-minute walk test (6-MWT) and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). COPD was diagnosed according to GOLD criteria. Restrictive lung function was defined as FEV1/FVC ≥0.70 and FVC <80% of predicted value. The BODE and ADO index, risk scores in COPD patients, were calculated.ResultsAlmost 40% fulfilled the criteria of COPD and 7% had restrictive lung disease, the latter being excluded from further analysis. Noteworthy, 63% of the COPD patients were undiagnosed and 8% of those without COPD used inhalation therapy. Patients with COPD had more shortness of breath despite little difference in HF severity and similar other comorbidities. KCCQ was significantly worse in COPD patients. The ADO and BODE indices were significantly different.ConclusionCOPD is very common in unselected HF patients. It was often not diagnosed and many patients received treatment without being diagnosed with COPD. Presence of COPD worsens symptoms and negatively effects cardiac specific QOL.

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