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

Cuthbert, Joseph J.; Kearsley, Joshua W.; Kazmi, Syed; Kallvikbakka-Bennett, Anna; Weston, Joan; Davis, Julie; Rimmer, Stella; Clark, Andrew L.


Joshua W. Kearsley

Syed Kazmi

Anna Kallvikbakka-Bennett

Joan Weston

Julie Davis

Stella Rimmer

Andrew L. Clark


© 2018, The Author(s). 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 (FEV1) 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.


Cuthbert, J. J., Kearsley, J. W., Kazmi, S., Kallvikbakka-Bennett, A., Weston, J., Davis, J., …Clark, A. L. (2019). The impact of heart failure and chronic obstructive pulmonary disease on mortality in patients presenting with breathlessness. Clinical Research in Cardiology, 108(2), 185–193.

Journal Article Type Article
Acceptance Date Jul 18, 2018
Online Publication Date Aug 8, 2018
Publication Date 2019-02
Deposit Date Jul 24, 2018
Publicly Available Date Oct 27, 2022
Print ISSN 1861-0684
Electronic ISSN 1861-0692
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 108
Issue 2
Pages 185–193
Keywords Heart failure; Chronic obstructive pulmonary disease; COPD; Mortality; Outcome prognosis
Public URL
Publisher URL


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Copyright Statement
© The Author(s) 2018<br /> Open Access<br /> This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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