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

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

Authors

Marilyn Etheridge

Joshua W. Kearsley

Syed Kazmi

Anna Kallvikbakka-Bennett

Joan Weston

Julie Davis

Stella Rimmer

Andrew L. Clark



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.

Journal Article Type Article
Publication Date 2019-02
Print ISSN 1861-0684
Electronic ISSN 1861-0692
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 108
Issue 2
Pages 185–193
APA6 Citation 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. https://doi.org/10.1007/s00392-018-1342-z
DOI https://doi.org/10.1007/s00392-018-1342-z
Keywords Heart failure; Chronic obstructive pulmonary disease; COPD; Mortality; Outcome prognosis
Publisher URL https://link.springer.com/article/10.1007%2Fs00392-018-1342-z

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Copyright Statement
© The Author(s) 2018
Open Access
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), 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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