The Presence Of Clinical COPD Predicts Mortality In Heart Failure Patient Population

Background Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with heart failure (HF). Limited data is available on the prognostic impact of COPD on HF outcomes and the differences in patients with preserved versus reduced HF with comorbid COPD. Hypothesis The presence of clinical COPD in multivariate analysis predicts mortality in patients with HF, with a higher risk in patients with HFrEF Methods Patients > 18 years of age discharged from our institution between 1/2/2015 and 9/18/2020 with a diagnosis of HF were included. Patients were stratified into 2 groups based on ejection fraction (HFpEF, EF[ST1] [DW2] ≥ 40% and HFrEF, EF < 40%). Patients were matched by name and DOB to CT Vital Statistics (Death records through 12/31/2020). The Demographics, clinical factors, and outcomes, including mortality, were evaluated. Cox regression compared mortality in HF/COPD groups. Results A total of 3041 patients were identified, 1943 (63.9%) had HFpEF, and 1098 (36.1%) had HFrEF. HFpEF patients were older, more likely to be female, and had a higher BMI. There was no difference in median LOS (p=0.09) or in-hospital mortality (p=0.52) by HF type. A clinical diagnosis of COPD was present in 925 patients (30.4%). More patients with HFpEF had concurrent COPD (33.5% compared to 25%, p <0.001). Among HFrEF patients, there was no difference in median LOS when COPD was present compared to when not present (p=0.22). In contrast, among HFpEF patients, those with COPD had longer median LOS (p<0.0001[ST3] [DW4] ).Four diagnosis groups were created using HF type and COPD diagnosis (HFpEF-COPD, HFpEF-No COPD, HFrEF-COPD, HFrEF-No COPD). A Cox regression analysis that included covariates: diagnosis group, age group, gender, BMI class, ethnicity, AFib, diabetes, anemia, CVA/TIA, dialysis, prior MI, HgB, BUN, sodium, edema (at discharge), ACE/ARB, Beta-blocker, calcium channel blocker (all at discharge) examined survival for each diagnosis group and produced hazard ratios for each covariate, Kaplan-Meier survival curve is shown in Figure 1. HFpEF patients without COPD were approximately 27% less likely to die than both HFrEF patients with no COPD and HFpEF patients with COPD and were 30% less likely to die than HFrEF patients with COPD. There were no other significant differences by group. Conclusion A clinical diagnosis of COPD resulted in increased mortality for HFrEF and HFpEF patients. In HFpEF, the presence of COPD resulted in increased LOS during hospital admission and a mortality rate akin to HFrEF patients without COPD over the following 5.5 years. COPD is an important predictor of HF survival and should focus on improved outcomes. Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with heart failure (HF). Limited data is available on the prognostic impact of COPD on HF outcomes and the differences in patients with preserved versus reduced HF with comorbid COPD. The presence of clinical COPD in multivariate analysis predicts mortality in patients with HF, with a higher risk in patients with HFrEF Patients > 18 years of age discharged from our institution between 1/2/2015 and 9/18/2020 with a diagnosis of HF were included. Patients were stratified into 2 groups based on ejection fraction (HFpEF, EF[ST1] [DW2] ≥ 40% and HFrEF, EF < 40%). Patients were matched by name and DOB to CT Vital Statistics (Death records through 12/31/2020). The Demographics, clinical factors, and outcomes, including mortality, were evaluated. Cox regression compared mortality in HF/COPD groups. A total of 3041 patients were identified, 1943 (63.9%) had HFpEF, and 1098 (36.1%) had HFrEF. HFpEF patients were older, more likely to be female, and had a higher BMI. There was no difference in median LOS (p=0.09) or in-hospital mortality (p=0.52) by HF type. A clinical diagnosis of COPD was present in 925 patients (30.4%). More patients with HFpEF had concurrent COPD (33.5% compared to 25%, p <0.001). Among HFrEF patients, there was no difference in median LOS when COPD was present compared to when not present (p=0.22). In contrast, among HFpEF patients, those with COPD had longer median LOS (p<0.0001[ST3] [DW4] ).Four diagnosis groups were created using HF type and COPD diagnosis (HFpEF-COPD, HFpEF-No COPD, HFrEF-COPD, HFrEF-No COPD). A Cox regression analysis that included covariates: diagnosis group, age group, gender, BMI class, ethnicity, AFib, diabetes, anemia, CVA/TIA, dialysis, prior MI, HgB, BUN, sodium, edema (at discharge), ACE/ARB, Beta-blocker, calcium channel blocker (all at discharge) examined survival for each diagnosis group and produced hazard ratios for each covariate, Kaplan-Meier survival curve is shown in Figure 1. HFpEF patients without COPD were approximately 27% less likely to die than both HFrEF patients with no COPD and HFpEF patients with COPD and were 30% less likely to die than HFrEF patients with COPD. There were no other significant differences by group. A clinical diagnosis of COPD resulted in increased mortality for HFrEF and HFpEF patients. In HFpEF, the presence of COPD resulted in increased LOS during hospital admission and a mortality rate akin to HFrEF patients without COPD over the following 5.5 years. COPD is an important predictor of HF survival and should focus on improved outcomes.