MedWire News: Results of a Dutch study show that the presence of heart failure is a significant independent predictor of all-cause mortality in patients with chronic obstructive pulmonary disease (COPD).
Writing in the European Journal of Heart Failure, Frans Rutten (University Medical Center Utrecht) and team explain: “Heart failure and COPD affect many elderly patients and are both major causes of death. Moreover, heart failure is often concurrently present in elderly patients with COPD, and the combination presents many diagnostic and therapeutic dilemmas.”
However, they add that “there has been a lack of data quantifying the prognostic significance of heart failure in patients with COPD.”
To address this, the researchers studied data on 405 COPD patients, aged at least 65 years at baseline, without a previous diagnosis of heart failure who underwent extensive diagnostic investigations using electrocardiography, chest X-ray, blood tests, pulmonary function tests, and echocardiography between 2001 and 2003.
Results form these tests revealed that 82 patients had previously unrecognized heart failure – mainly left-sided heart failure.
Over a mean follow-up period of 4.5 years, 60 patients died.
The researchers found that mortality was significantly higher in COPD patients with concurrent heart failure than in those without heart failure, at 25.6% versus 12.1%, respectively. Among patients who died, 36.7% died from cardiovascular disease, 26.7% from respiratory disease, and 15.0% from malignancies or unknown causes.
After accounting for gender, age, history of ischemic heart disease, hypertension, diabetes mellitus, atrial fibrillation, smoking, COPD severity, and other baseline variables, the researchers calculated that COPD patients with heart failure had a 2.1-fold greater risk for all-cause mortality than those with the heart condition.
Rutten and team conclude: “Previously unknown left-sided heart failure has a clear, independent negative effect on all-cause mortality in patients with COPD.”
The researchers advise that “physicians should be alert for the slow onset development of concurrent heart failure in patients with a diagnosis of COPD. Importantly, development of concurrent heart failure is masked by the similarity of symptoms in patients with COPD.”
They add: “Future studies should be directed to further disentangle the complex relationship between heart failure and COPD. Such research could possibly open up new treatment pathways for patients with COPD, with or without concurrent heart failure.”
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