Clinical Investigation
COPD Predicts Mortality in HF: The Norwegian Heart Failure Registry

https://doi.org/10.1016/j.cardfail.2009.12.002Get rights and content

Abstract

Background

Chronic obstructive pulmonary disease (COPD) and chronic heart failure (HF) are common clinical conditions that share tobacco as a risk factor. Our aim was to evaluate the prognostic impact of COPD on HF patients.

Methods and Results

The Norwegian Heart Failure Registry was used. The study included 4132 HF patients (COPD, n = 699) from 22 hospitals (mean follow-up, 13.3 months). COPD patients were older, more often smokers and diabetics, less often on β-blockers and had a higher heart rate. They were more often in New York Heart Association (NYHA) Class III or IV (COPD, 63%; no COPD, 51%), although left ventricular ejection fraction (LVEF) distribution was similar. COPD independently predicted death (adjusted hazard ratio [HR], 1.188; 95% CI: 1.015 to 1.391; P = 0.03) along with age, creatinine, NYHA Class III/IV (HR, 1.464; 95% CI: 1.286 to 1.667) and diabetes. β-blockers at baseline were associated with improved survival in patients with LVEF ≤40% independently of COPD.

Conclusion

COPD is associated with a poorer survival in HF patients. COPD patients are overrated in terms of NYHA class in comparison with patients with similar LVEF. Nonetheless, NYHA class remains the strongest predictor of death in these patients.

Section snippets

Methods

The Norwegian Heart Failure Registry was used. Patients from 26 hospitals with new heart failure, diagnosed between January 2000 and February 2008, were offered inclusion in the registry and were recruited both from in-house and outpatient clinics. Inclusion was done prospectively. Our study was limited to the patients from 22 hospitals for which COPD status (with or without COPD) was available. Data were collected by trained and experienced data collectors using the internationally accepted

Results

COPD status (COPD, n = 699; no COPD, n = 3433) was available for 4132 participants (women, n = 1211 [29%]; men, n = 2921 [71%]) from 22 hospitals. Patients were followed until the last clinical visit or death for a mean follow-up of 13.3 months. Baseline characteristics of the 2 groups are presented in Table 1. Patients' age was similar (COPD, 71 years; no COPD, 70 years; P = .06). Female patients were equally represented in the 2 groups (COPD, 30%; no COPD, 29%; P = .77). Coronary artery

Discussion

This study is, as far as we know, one of the world's largest to evaluate the impact of COPD in HF patients. It shows that COPD has an impact on survival in these patients who are already subject to a high mortality risk. Although there still is a debate on whether COPD is really a risk factor for atherosclerotic events, which was recently shown by Hawkins and colleagues not to be,8 COPD can complicate the diagnosis of HF and interact with its natural history. COPD can sometimes be misdiagnosed

Conclusion

COPD is independently associated with a poorer survival in HF patients. COPD patients are overrated in terms of NYHA class in comparison with other heart failure patients with similar LVEF. Nonetheless, NYHA class remains the strongest predictor of death, suggesting that, even though symptoms might be of a dual cause, they still are a very potent predictor of outcome in these patients.

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    The authors have no conflicts to disclose.

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