Heart Failure in Patients With Exacerbations of COPD

In patients hospitalized with exacerbations of chronic obstructive pulmonary disease (ECOPD), better diagnosis and treatment of coexisting heart failure (HF) is needed to improve patient outcomes, according to an observational study published in Respiratory Medicine.

Chronic obstructive pulmonary disease and HF share risk factors and often coexist, with HF frequently being undiagnosed in patients with COPD. In particular, patients surviving hospitalization for ECOPD are at an increased risk for cardiovascular events.

In the current study, researchers retrospectively examined the investigation and management of HF in patients hospitalized with ECOPD in 2 hospitals in the United Kingdom between 2017 and 2020. Of 476 patients, 94 (19.7%) had known HF on admission; among the remaining 382 patients, 89 (23.3%) were investigated within 100 days of admission and HF was confirmed in 38.

Investigators found 33 patients with heart failure with reduced ejection fraction (HFrEF); of these, only 18 (54.5%) received treatment with an angiotensin-converting enzyme (ACE)-inhibitor and beta-blocker. In addition, the researchers found that during follow up (median 11.7 months), 77/132 patients (58.3%) with HF and 108/344 patients (31.4%) without HF died (P <.001).

Study investigators noted that it can be difficult to distinguish whether worsening breathlessness in patients with COPD is a symptom of that disease or of cardiac failure. They added, however, that an appropriate test for such patients is the N-terminal prohormone of brain natriuretic peptide (NT-proBNP), which is recognized as a reliable test for identifying patients in need of cardiac functional imaging, such as echocardiography.

“We have shown, in a generalizable population of patients hospitalized with COPD exacerbations, that HF is common and, even when diagnosed, is undertreated,” the researchers concluded. They added, “There is an urgent clinical need for further research in this area, including the clinical  and health economic impact of structured cardiovascular assessment with optimization of treatment in patients hospitalized with ECOPD.”

Reference

Hesse K, Bourke S, Steer J. Heart failure in patients with COPD exacerbations: Looking below the tip of the iceberg. Respir Med. Published online March 1, 2022. doi:10.1016/j.rmed.2022.106800