Chronic evidence-based heart failure medications beneficially affect in-hospital prognosis in patients with acute heart failure and concomitant chronic obstructive pulmonary disease

Abstract

Aim: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of hospitalization for heart failure (HF) compared to patients without COPD. No efficient data exist regarding the impact of chronic HF medications on in-hospital prognosis in COPD patients with an acute heart failure (AHF) episode. This ALARM-HF sub-analysis investigates if renin-angiotensin-system (RAS) blocker (angiotensin-converting enzyme inhibitors and angiotensin II receptor I blockers) as well as beta-blocker prescription, is associated with lower in-hospital mortality in patients hospitalized for AHF with concomitant COPD. Methods: ALARM-HF was a retrospective observational registry included 4,953 patients admitted for AHF in 6 European countries, Turkey, Mexico and Australia. Of these, COPD data were available in 4,616 patients. Backward and forward stepwise multivariate logistic regression analyses were used to determine the independent predictors of in-hospital mortality. Results: Overall, 1,075 subjects were classified as having both AHF and COPD. On hospital admission, 34% and 22% of patients were using RAS-blockers and beta-blockers, respectively. During in-hospital length stay, 100 AHF patients with COPD died. After adjusting for potential confounders (age, gender, systolic blood pressure, left ventricular ejection fraction and various comorbidities) RAS-blocker (hazard ratio [HR] 0.39, 95% confidence interval [CI]: 0.23–0.67; p=0.001) and beta-blocker (HR 0.48, 95% CI: 0.26–0.89; p=0.019) use prior to hospitalization was significantly and independently associated with lower in-hospital mortality in this patient population. Multivariate analysis also demonstrated the following parameters as independent predictors of increased in-hospital mortality in AHF patients with COPD: age>70 years (1.52 OR: 1.27-1.69, p=0.001), systolic blood pressure at admission <100 mmHg (1.22 OR: 1.17-1.25, p=0.001), history of smoking (1.76 OR: 1.14-2.70, p=0.011) and pre-existed coronary artery disease (1.98 OR: 1.28-2.88, p=0.002). Conclusion: RAS-blockers and beta-blockers have protective properties in COPD patients altering in-hospital prognosis after an AHF episode. These findings need confirmation in prospective clinical trials.