Chronic obstructive pulmonary disease (COPD) is associated with lower use of beta-blockers and worse health status and is an independent predictor of cardiovascular and noncardiovascular hospitalizations, according to study results published in the Journal of the American Heart Association.

New treatments for heart failure with reduced ejection fraction (HFrEF) may be particularly important in patients with concomitant COPD because COPD is a common comorbidity in HFrEF and is associated with undertreatment and worse outcomes. Therefore, researchers examined outcomes in 8399 patients with HFrEF according to COPD status who were involved in the PARADIGM-HF trial (ClinicalTrials.gov Identifier: NCT01035255). Cox regression models were used to compare COPD vs non-COPD subgroups and the effects of sacubitril/valsartan vs enalapril.

Patients with COPD (n=1080; 12.9%) were older than patients without COPD (mean age, 67 vs 63 years; P <.001), with similar left ventricular ejection fraction (29.9% vs 29.4%; P =.018), but higher N-terminal pro-B-type natriuretic peptide (NT-proBNP; median, 1741 pg/mL vs 1591 pg/mL; P =.011), worse functional class (New York Heart Association III/IV, 37% vs 23%; P <.001) and Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (73.4 vs 81.2; P <.001), and more congestion and comorbidity. Medical therapy was similar in patients with and without COPD except for beta-blockers (86.5% vs 94.0%; P <.001) and diuretics (84.6% vs 79.6%; P <.001).


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After multivariable adjustment, COPD was associated with higher risks of HF hospitalization, and the composite of cardiovascular death or HF hospitalization, but not cardiovascular death, or all-cause mortality. COPD was also associated with higher risk of all cardiovascular hospitalization and noncardiovascular hospitalization. The benefit of sacubitril/valsartan over enalapril was consistent in patients with and without COPD for all end points.

“In conclusion, patients with HF and concurrent COPD have greater comorbidity and higher risk of HF and noncardiovascular hospitalization but not mortality,” stated the authors.

Disclosure: This clinical trial was supported by Novartis. Please see the original reference for a full list of authors’ disclosures.  

Reference

Ehteshami‐Afshar S, Mooney L, Dewan P, et al. Clinical characteristics and outcomes of patients with heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: insights from PARADIGM‐HF. J Am Heart Assoc. Published online January 30, 2021. doi:10.1161/JAHA.120.019238