Monday, December 17, 2018

Severe comorbid COPD increases mortality risk in heart failure patients

Heart failure and chronic obstructive pulmonary disease (COPD) are common diseases of aging. Besides being common in old age, both diseases share common risk factors and pathophysiology. As a result, the two often co-exist and influence each other’s clinical course.

This observation has been validated in a new nested case-control study of more than 50,000 UK patients with heart failure from the UK, which found that the greater severity of COPD is associated with increased chances of hospitalizations and increased risk of death in those patients who also have heart failure.  Hence, optimal care of patients with comorbid heart failure and COPD requires accurate diagnosis and targeting of severe COPD markers to prevent admissions and death.

The study showed that the increased risk of death and hospitalization associated with COPD significantly differs by medication intensity and the severity of airflow limitation.

Chronic obstructive pulmonary disease was not associated with any increased risk of death when patients were managed by inhaler therapies, until prescribing intensity reached triple inhaler therapy and risks of both outcomes were significantly higher in those prescribed oral corticosteroids and oxygen therapy. The use of spirometry in the population studied was limited, but its use indicated the group of patients with more severe heart failure and COPD, who also had worse outcomes for those with the most severe airflow limitation

The major clinical implications of these findings are:

·         To improve HF prognosis, it is important to accurately identify and effectively manage comorbidities.
·         COPD-associated risk differed significantly according to medication intensity in patients with heart failure; hence, it is a potential indicator of disease progression. 
·         Comparison of patients with heart failure and COPD with those without COPD showed that mortality was higher in those who had more severe airflow limitation from GOLD stages 1 through 4. 
·         COPD in women with heart failure was associated with a 15% higher risk of death than in men. 

These findings are reported in JAMA Network Open, Dec. 14, 2018.

(Source: Association of medication intensity and stages of airflow limitation with the risk of hospitalization or death in patients with heart failure and chronic obstructive pulmonary disease. JAMA Netw Open. 2018;1(8):e185489)

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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