Clinical InvestigationCongestive Heart FailureChronic obstructive pulmonary disease in heart failure. Prevalence, therapeutic and prognostic implications
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
References (40)
- et al.
Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure
J Am Coll Cardiol
(2003) - et al.
The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction
J Am Coll Cardiol
(2000) - et al.
Impaired renal function in patients with ischemic and nonischemic chronic heart failure: association with neurohormonal activation and survival
Am Heart J
(2004) - et al.
Prognostic impact of diabetes mellitus in patients with heart failure according to the etiology of left ventricular systolic dysfunction
J Am Coll Cardiol
(2001) - et al.
Anemia is associated with worse symptoms, greater impairment of functional capacity and a significant increase in mortality in patients with advanced heart failure
J Am Coll Cardiol
(2002) - et al.
Spectrum of heart failure in older patients: results from National Heart Failure project
Am Heart J
(2002) - et al.
Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients
Ann Epidemiol
(2006) - et al.
COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanent Medical Care Program
Chest
(2005) - et al.
Right and left ventricular dysfunction in patients with severe pulmonary disease
Chest
(1998) - et al.
Left ventricular dysfunction in deteriorating patients with chronic obstructive pulmonary disease
Chest
(1995)
Cardioselective beta-blockers for chronic obstructive pulmonary disease: a meta-analysis
Respir Med
Detrimental effects of beta-blockers in COPD: a concern for nonselective beta-blockers
Chest
Tolerability of carvedilol in patients with heart failure and concomitant chronic obstructive pulmonary disease or asthma
J Heart Lung Transplant
Therapeutic Update: non-selective beta-and alpha-adrenergic blockade in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure
J Am Coll Cardiol
Diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure
J Am Coll Cardiol
Frequent non-cardiac comorbidities in patients with chronic heart failure
Eur J Heart Fail
Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study
Circulation
Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus. Results from the ATLAS trial
Eur Heart J
Renal function, neurohormonal activation, and survival in patients with chronic heart failure
Circulation
Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Investigators. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure
Circulation
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Ana Azevedo is also affiliated with Serviço de Higiene e Epidemiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.