Abstract
The appropriate treatment for patients with coexistent chronic obstructive pulmonary disease (COPD) and heart failure (HF) remains unclear. Data from the Taiwan National Health Insurance Research Database was used for this retrospective cohort study. Patients diagnosed with both diseases between 1997 and 2012 were enrolled as the COPD-heart failure overlap cohort. Patients were categorized as non-users and users of specific COPD and HF medications. Medication prescriptions in each 3-month and 1-year period served as time-dependent covariates. The primary endpoint was cumulative survival. The validation study confirmed the accuracy of definitions of COPD (94.0% sensitivity) and HF (96.3% sensitivity).The study included 275,436 patients with COPD-heart failure overlap, with a mean follow-up period of 9.32 years. The COPD-heart failure overlap cohort had more medical service use and higher mortality than did the COPD alone cohort. Use of inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) combinations, long-acting muscarinic antagonist (LAMA), angiotensin receptor blockers (ARBs), β blockers, aldosterone antagonists, and statins reduced mortality risk compared with non-use. Sensitivity and subgroup analyses confirmed the consistency and robustness of results.ICS/LABA combinations, LAMA, ARBs, β blockers, aldosterone antagonists, and statins use was associated with a lower mortality risk in patients with COPD-heart failure overlap.
Highlights
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are major global health issues characterized by high mortality and morbidity [1, 2]
After the application of exclusion criteria, the study cohort consisted of 611,618 patients with COPD alone and 275,436 patients with COPD-heart failure overlap (Figure 1)
We identified the following independent risk factors for mortality in the COPD-heart failure overlap cohort: age ≥ 65 years (HR, 1.59; 95% confidence interval (CI), 1.59–1.60), male sex (HR, 1.11; 95% CI, 1.11–1.12), diabetes mellitus (HR, 1.07; 95% CI, 1.07– 1.07), hypertension (HR, 1.05; 95% CI, 1.04–1.05), cerebrovascular disease (HR, 1.06; 95% CI, 1.06–1.06), malignancy (HR, 1.24; 95% CI, 1.24–1.24), chronic kidney disease (HR, 1.03; 95% CI, 1.03–1.03), and Charlson Comorbidity Index > 1 (HR, 1.03; 95% CI, 1.03–1.03; all p < 0.0001; Supplementary Table 1)
Summary
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are major global health issues characterized by high mortality and morbidity [1, 2]. The COPD-heart failure overlap leads to important therapeutic challenges. Β blockers are established therapy for HF, this class of drugs is often underused in patients with COPD-HF overlap [3]. Patients receiving ARBs were less likely to have cough compared with those receiving ACEIs [4]. ACEIrelated cough could lead to bronchial hyperresponsiveness [5]. The presence of bronchial hyperresponsiveness in COPD is associated with increased mortality [6]. The aim of this study was to investigate the survival effects of medications recommended in guidelines for patients with COPD-heart failure overlap using a populationbased nationwide dataset
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