Increasing COPD Severity Ups Risk of Mortality in HF Patients

Previous research has found that heart failure (HF) patients who also have chronic obstructive pulmonary disease (COPD) have a greater likelihood of poor outcomes. And according to a new study, COPD severity also plays a role in mortality and hospitalization risk in these patients.  

Researchers used international COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD]) guidelines to stratify COPD patients by seven medication intensity levels and four airflow limitation severity stages, and they looked at forced expiratory volume in 1 second (FEV1) data. They compared newly diagnosed HF patients with COPD to those without COPD. 

A total of 50,114 patients received new HF diagnoses (median age, 79 years; 46% women); of whom 18,478 (13.8%) had COPD. The presence of COPD greatly increased patients’ risk of mortality (adjusted odds ratio [AOR], 1.31; 95% CI, 1.26-1.36) and hospitalization (AOR, 1.33; 95% CI, 1.26-1.39). When looking at medication intensity levels, the top three were each associated with increasing mortality risk: full inhaler therapy (AOR, 1.17; 95% CI, 1.06-1.29) to oral corticosteroids (AOR, 1.69; 95% CI, 1.57-1.81) to oxygen therapy (AOR, 2.82; 95% CI, 2.42-3.28). The same pattern was observed for hospitalization rates: full inhaler therapy, 1.17 (95% CI, 1.03-1.33); oral corticosteroids, 1.75 (95% CI, 1.59-1.92); and oxygen therapy, 2.84 (95% CI, 1.22-3.63). As airflow limitation increased, so did mortality risk (FEV1 80% or more, AOR, 1.63 [95% CI, 1.42-1.87]; FEV1 50% to 79%, 1.69 [95% CI, 1.56-1.83]; FEV1 30% to 49%, 2.21 [95% CI, 2.01-2.42]; FEV1 less than 30%, 2.93 [95% CI, 2.49-3.43]). 

The researchers concluded, “In the UK HF community setting, increasing COPD severity was associated with increasing risk of mortality and hospitalization. Prescribed COPD medication intensity and airflow limitation provide the basis for targeting high-risk groups.” 

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Incidence of Hospitalisation for Heart Failure and Case-Fatality Among 3.25 Million People with and without Diabetes 

Asthma-COPD Overlap: What Is Known and What Is Not 

Source: JAMA