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.

Abstract

© 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.

Citation

Cuthbert, J. J., Kearsley, J. W., Kazmi, S., Kallvikbakka-Bennett, A., Weston, J., Davis, J., Rimmer, S., & 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. https://doi.org/10.1007/s00392-018-1342-z

• 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 19, 2018
• Print ISSN: 1861-0684
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 108
• Issue: 2
• Pages: 185–193
• DOI: https://doi.org/10.1007/s00392-018-1342-z
• Keywords: Heart failure; Chronic obstructive pulmonary disease; COPD; Mortality; Outcome prognosis
• Public URL: https://hull-repository.worktribe.com/output/942093
• Publisher URL: https://link.springer.com/article/10.1007%2Fs00392-018-1342-z
• Contract Date: Jul 24, 2018