Heart failure
Impact of Chronic Obstructive Pulmonary Disease on Long-Term Outcome of Patients Hospitalized for Heart Failure

https://doi.org/10.1016/j.amjcard.2007.08.046Get rights and content

Chronic obstructive pulmonary disease (COPD) is a frequently neglected co-morbidity in patients with heart failure (HF). The aim of this study was to evaluate the prognostic impact of COPD in patients hospitalized for HF. Consecutive patients (n = 799) admitted for a first episode of HF in all healthcare establishments of the Somme department (France) during 2000 were prospectively enrolled. Baseline characteristics and long-term prognosis were compared according to COPD status. COPD was diagnosed in 156 patients (19.5%). Compared with the no-COPD group, patients with COPD were predominantly men, more often smokers, and had lower discharge prescription rates of β blockers (6% vs 27%, p <0.001). Five-year survival rate in patients with COPD was significantly lower than that of the no-COPD group (31% vs 42%, p = 0.03). Compared with the expected survival of the age- and gender-matched general population, the 5-year survival rate in patients with COPD was dramatically lower (31% vs 71%). On multivariable analysis, COPD was a strong predictor of poorer outcome (hazard ratio 1.53, 95% confidence interval 1.21 to 1.94, p <0.001). COPD was an independent predictor of mortality in patients with preserved left ventricular ejection fraction and in patients with reduced ejection fraction. In conclusion, patients with HF and associated COPD have a poor prognosis with an impressive excess mortality compared to HF patients without COPD and the general population. Beta-blocker prescription rates remain deceivingly low in this category of patients with HF.

Section snippets

Methods

The Somme is a department of France with a population of 555,551 inhabitants, according to the 1999 census. The Somme department has 11 healthcare establishments, managing patients with HF: 1 university hospital, 7 general hospitals, 2 private clinics, and 1 medium and long-stay unit. General practitioners, cardiologists, and internal physicians of these centers agreed to participate in this study.

Consecutive patients >20 years old hospitalized for a first episode of HF in any of these

Results

The study population comprised 799 patients (mean age 75 ± 12 years). One hundred fifty-six patients (19.5%) had a history of COPD. Table 1 presents the baseline characteristics of patients with and without COPD. Patients with COPD were predominantly men and more often smokers. Etiologies, prevalence of other noncardiac co-morbidities, and results of complementary investigations were comparable between the 2 groups.

Significant differences were observed between the 2 groups for prescription of

Discussion

This is the first study to specifically examine the prognostic impact of COPD in patients with HF. Our population, recruited from all healthcare establishments of the Somme department (France) in 2000, accurately reflects the modern demography of patients with HF. Relative survival curves diverged relatively late, after 1 year of follow-up, suggesting the low impact of COPD on short-term outcome. The long-term prognosis of patients with HF and COPD was poor with 5-year mortality as high as 69%,

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    This study was funded by a grant from the French Ministry of Health, Paris, France.

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