Clinical Investigation
Congestive Heart Failure
Chronic obstructive pulmonary disease in heart failure. Prevalence, therapeutic and prognostic implications

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Background

Patients with heart failure (HF) frequently have comorbidities. Frequency, prognostic, and therapeutic implications of chronic obstructive pulmonary disease (COPD) in HF are largely unknown. We aimed to assess the prevalence and prognostic implications of COPD in a sample of stable patients with HF and to determine the frequency of β-blocker (bB) use and rate of withdrawal according to COPD coexistence.

Methods

We conducted a retrospective cohort study including 186 patients followed in an outpatient HF clinic. All patients had left ventricular systolic dysfunction and a spirometry result. Patients were classified according to the GOLD guidelines. Treatment was instituted at the discretion of the attending physicians. Prognosis was compared between groups using Cox proportional hazards regression. The primary end point was death or all-cause hospitalization.

Results

The prevalence of COPD was 39.2% (73/186). No difference was detected between the COPD and non-COPD groups in the rate of bB use (86.3% vs 87.6%, P = .97) and withdrawal (11.1% and 8.1%, P = .71). Mean follow-up was 14.2 ± 8.8 months. The primary end point occurred in 71 (38.2%) patients—32 in the COPD group and 39 in the remaining (43.8% and 34.5%, respectively; hazard ratio 1.40, 95% CI 0.88-2.24). Severe COPD (GOLD stages III and IV) was associated with an adverse outcome (hazard ratio 2.10, 95% CI 1.05-4.22).

Conclusions

We observed a high COPD prevalence in stable patients with HF. Severe COPD predicted worse prognosis. Rates of bB use were high and rates of bB withdrawal were low; both were independent of COPD.

Section snippets

Methods

We evaluated a cohort of 334 patients with HF followed in an outpatient HF clinic. In this study, only patients with LVSD (ejection fraction <45% or depressed systolic function by eyeball assessment in echocardiographic evaluation) and HF signs and/or symptoms were included. In addition, patients had to be clinically stable and have a spirometry result available to be included. In our HF clinic, all patients have a spirometry done upon initial assessment unless unable to cooperate. Seventy-two

Results

Baseline characteristics of the 186 patients are presented in Table I. Patients' mean age was 67.2 ± 12.0 years; 69.9% were men and almost half had severe LVSD (48.9%) and HF of ischemic etiology (49.5%). The mean (±SD) follow-up time was 433 ± 268 days, with 64 (34%) patients reaching the maximum follow-up of 24 months (730 days). A total of 73 patients met classification criteria for COPD (prevalence 39.2%). The distribution of patients according to GOLD guidelines' stages is also shown in

Discussion

We observed a high prevalence of COPD in a cohort of elderly stable patients with HF. Our results suggest that severe COPD (GOLD stages III and IV) is associated with a worse prognosis in patients with HF. In addition, we observed a high rate of bB use in the whole group that was independent of the coexistence of COPD. The global bB withdrawal was low and similar in patients with and without COPD.

There is a well-known association between COPD and HF. Several reports found a high prevalence of

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    1

    Ana Azevedo is also affiliated with Serviço de Higiene e Epidemiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

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