The impact of heart failure and chronic obstructive pulmonary disease on mortality in patients presenting with breathlessness

• Published in: Clinical research in cardiology Vol. 108; no. 2; pp. 185 - 193
• Main Authors: Cuthbert, Joseph J., Kearsley, Joshua W., Kazmi, Syed, Kallvikbakka-Bennett, Anna, Weston, Joan, Davis, Julie, Rimmer, Stella, Clark, Andrew L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2019; Springer Nature B.V
• Subjects: Aged; Beta blockers; Brain natriuretic peptide; Cardiology; Chronic obstructive pulmonary disease; Confidence intervals; Death; Dyspnea - etiology; Dyspnea - mortality; Echocardiography; Female; Follow-Up Studies; Forced Expiratory Volume; Heart diseases; Heart failure; Heart Failure, Systolic - complications; Heart Failure, Systolic - mortality; Heart Failure, Systolic - physiopathology; Humans; Lung diseases; Male; Medicine; Medicine & Public Health; Mortality; Obstructive lung disease; Original Paper; Patients; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; Retrospective Studies; Risk; Risk Assessment; Risk Factors; Spirometry; Stroke Volume; Survival Rate - trends; United Kingdom - epidemiology; Ventricle; United Kingdom; Heart failure; Chronic obstructive pulmonary disease; Prognosis; Mortality; Outcome; COPD
• DOI: 10.1007/s00392-018-1342-z
• ISSN: 1861-0684

Background Differentiating heart failure from chronic obstructive pulmonary disease (COPD) in a patient presenting with breathlessness is difficult but may have implications for outcome. We investigated the prognostic impact of diagnoses of COPD and/or heart failure in consecutive patients presenting to a secondary care clinic with breathlessness. Methods In patients with left ventricular systolic dysfunction (LVSD) by visual estimation, N-terminal pro B-type natriuretic peptide (NTproBNP) levels and spirometry were evaluated ( N  = 4986). Heart failure was defined as either LVSD worse than mild (heart failure with reduced ejection fraction) or LVSD mild or better and raised NTproBNP levels (> 400 ng/L) (heart failure with normal ejection fraction). COPD was defined as forced expiratory volume in 1 s (FEV 1 ) to forced vital capacity (FVC) ratio < 0.7. The primary outcome was all-cause mortality. Results 1764 (35%) patients had heart failure alone, 585 (12%) had COPD alone, 1751 (35%) had heart failure and COPD, and 886 (18%) had neither. Compared to patients with neither diagnosis, those with COPD alone [hazard ratio (HR) = 1.84 95% confidence interval (CI) 1.40–2.43], heart failure alone [HR = 4.40 (95% CI 3.54–5.46)] or heart failure and COPD [HR = 5.44 (95% CI 4.39–6.75)] had a greater risk of death. COPD was not associated with increased risk of death in patients with heart failure on a multivariable analysis. Conclusion While COPD is associated with increased risk of death compared to patients with neither heart failure nor COPD, it has a negligible impact on prognosis amongst patients with heart failure.