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

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

doi:10.1007/s00392-018-1342-z

Joseph J Cuthbert, Joan Weston + Show 6 more

Open Access

https://doi.org/10.1007/s00392-018-1342-z

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Abstract

BackgroundDifferentiating 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.MethodsIn 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.Results1764 (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.ConclusionWhile 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.

Highlights

Heart failure was defined as the presence of signs and symptoms of the disease and either left ventricular dysfunction (LVSD) worse than mild—heart failure and reduced ejection fraction (HeFREF); or left ventricular systolic dysfunction (LVSD) mild or better and N-terminal peptide of pro B-type natriuretic peptide (NTproBNP) level > 400 ng/L—HeFNEF [24]
chronic obstructive pulmonary disease (COPD) was defined as FEV1:forced vital capacity (FVC) < 0.7 as
The prevalence of COPD reported in the medical record (10% for HeFREF; 10% HeFNEF) was far lower than the prevalence of COPD by spirometry (49% for HeFREF; 51% for HeFNEF), but was Missing All patients

Summary

Introduction

Separating heart failure from chronic obstructive airways disease (COPD), both or neither can be difficult due to similarity in symptomatology These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) below 0.7 indicates obstructive pulmonary disease [4], and many patients with heart failure have obstructive spirometry [5, 6]. Differentiating heart failure from chronic obstructive pulmonary disease (COPD) in a patient presenting with breathlessness is difficult but may have implications for outcome. 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. 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

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