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Domínguez-Rodríguez A, Hernandez-Vaquero D, Suero-Mendez C, Burillo-PutzE G, Gil V, Calvo-Rodriguez R, Piñera-Salmeron P, Llorens P, Martín-Sánchez FJ, Abreu-Gonzalez P, Miró Ò. Effects of MIdazolam versus MOrphine in acute cardiogenic pulmonary edema and chronic obstructive pulmonary disease: An analysis of MIMO trial. Am J Emerg Med 2023; 73:176-181. [PMID: 37703629 DOI: 10.1016/j.ajem.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
AIMS Chronic obstructive pulmonary disease (COPD) is an important comorbidity in heart failure. The MIMO trial showed that patients with acute cardiogenic pulmonary edema (ACPE) treated with midazolam had fewer serious adverse events than those treated with morphine. In this post hoc analysis, we examined whether the presence/ absence of COPD modifies the reduced risk of midazolam over morphine. METHODS Patients >18 years old clinically diagnosed with ACPE and with dyspnea and anxiety were randomized (1:1) at emergency department arrival to receive either intravenous midazolam or morphine. In this post hoc analysis, we calculated the relative risk (RR) of serious adverse events in patients with and without COPD. Calculating the CochranMantel-Haenszel interaction test, we evaluated if COPD modified the reduced risk of serious adverse events in the midazolam arm compared to morphine. RESULTS Overall, 25 (22.5%) of the 111 patients randomized had a history of COPD. Patients with COPD were more commonly men with a history of previous episodes of heart failure, than participants without COPD. In the COPD group, the RR for the incidence of serious adverse events in the midazolam versus morphine arm was 0.36 (95%CI, 0.1-1.46). In the group without COPD, the RR was 0.44 (95%CI, 0.22-0.91). The presence of COPD did not modify the reduced risk of serious adverse events in the midazolam arm compared to morphine (p for interaction =0.79). CONCLUSIONS The reduced risk of serious adverse events in the midazolam group compared with morphine is similar in patients with and without COPD.
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Affiliation(s)
- Alberto Domínguez-Rodríguez
- Department of Cardiology, Hospital Universitario de Canarias, Universidad Europea de Canarias, Tenerife, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Daniel Hernandez-Vaquero
- Cardiac Surgery Department, Central University Hospital of Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | | | - Victor Gil
- Emergency Department, Hospital Clinic, Barcelona, Institutd' Investigación Biomèdica August Pi iSunyer (IDIBAPS); University of Barcelona. Barcelona, Catalonia, Spain
| | | | | | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Spain
| | | | - Pedro Abreu-Gonzalez
- Department of Physiology, Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clinic, Barcelona, Institutd' Investigación Biomèdica August Pi iSunyer (IDIBAPS); University of Barcelona. Barcelona, Catalonia, Spain
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2
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Miró Ò, Conde-Martel A, Llorens P, Salamanca-Bautista P, Gil V, González-Franco Á, Jacob J, Casado J, Tost J, Montero-Pérez-Barquero M, Alquézar-Arbé A, Trullàs JC. The influence of comorbidities on the prognosis after an acute heart failure decompensation and differences according to ejection fraction: Results from the EAHFE and RICA registries. Eur J Intern Med 2023; 111:97-104. [PMID: 36914535 DOI: 10.1016/j.ejim.2023.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE The role of comorbidities in heart failure (HF) outcome has been previously investigated, although mostly individually. We investigated the individual effect of 13 comorbidities on HF prognosis and looked for differences according to left-ventricular ejection fraction (LVEF), classified as reduced (HFrEF), mildly-reduced (HFmrEF) and preserved (HFpEF). METHODS We included patients from the EAHFE and RICA registries and analysed the following comorbidities: hypertension, dyslipidaemia, diabetes mellitus (DM), atrial fibrillation (AF), coronary artery disease (CAD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), heart valve disease (HVD), cerebrovascular disease (CVD), neoplasia, peripheral artery disease (PAD), dementia and liver cirrhosis (LC). Association of each comorbidity with all-cause mortality was assessed by an adjusted Cox regression analysis that included the 13 comorbidities, age, sex, Barthel index, New York Heart Association functional class and LVEF and expressed as adjusted Hazard Ratios (HR) with 95% confidence intervals (95%CI). RESULTS We analysed 8,336 patients (82 years-old; 53% women; 66% with HFpEF). Mean follow-up was 1.0 years. Respect to HFrEF, mortality was lower in HFmrEF (HR:0.74;0.64-0.86) and HFpEF (HR:0.75;0.68-0.84). Considering patients all together, eight comorbidities were associated with mortality: LC (HR:1.85;1.42-2.42), HVD (HR:1.63;1.48-1.80), CKD (HR:1.39;1.28-1.52), PAD (HR:1.37;1.21-1.54), neoplasia (HR:1.29;1.15-1.44), DM (HR:1.26;1.15-1.37), dementia (HR:1.17;1.01-1.36) and COPD (HR:1.17;1.06-1.29). Associations were similar in the three LVEF subgroups, with LC, HVD, CKD and DM remaining significant in the three subgroups. CONCLUSION HF comorbidities are associated differently with mortality, LC being the most associated with mortality. For some comorbidities, this association can be significantly different according to the LVEF.
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Affiliation(s)
- Òscar Miró
- Emergency Department Hospital Clinic Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Alicia Conde-Martel
- Internal Medicine Department, University Hospital of Gran Canaria (Dr. Negrín), Spain
| | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization Hospital Doctor Balmis, Alicante, Spain
| | - Prado Salamanca-Bautista
- Internal Medicine Department, University Hospital Virgen Macarena of Sevilla University of Seville, Spain
| | - Víctor Gil
- Emergency Department Hospital Clinic Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge Hospitalet del Llobregat, Catalonia, Spain
| | - Jesús Casado
- Internal Medicine Department, University Hospital of Getafe, Madrid, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | | | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Joan Carles Trullàs
- Internal Medicine Department, Hospital d'Olot i comarcal de la Garrotxa, Olot, Girona, Catalonia, Spain; Laboratori de Reparació i Regeneració Tissular (TR2Lab) Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya Vic, Barcelona, Catalonia, Spain.
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3
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Cuthbert JJ, Pellicori P, Clark AL. Optimal Management of Heart Failure and Chronic Obstructive Pulmonary Disease: Clinical Challenges. Int J Gen Med 2022; 15:7961-7975. [PMID: 36317097 PMCID: PMC9617562 DOI: 10.2147/ijgm.s295467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common causes of breathlessness which frequently co-exist; one potentially exacerbating the other. Distinguishing between the two can be challenging due to their similar symptomatology and overlapping risk factors, but a timely and correct diagnosis is potentially lifesaving. Modern treatment for HF can substantially improve symptoms and prognosis for many patients and may have beneficial effects for patients with COPD. Conversely, while many inhaled treatments for COPD can improve symptoms and reduce exacerbations, there is conflicting evidence regarding the safety of some inhaled treatments for COPD in patients with HF. Here we explore the overlap between HF and COPD, examine the effect of one condition on the other, and address the challenges of managing patients with both conditions.
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Affiliation(s)
- Joseph J Cuthbert
- Centre for Clinical Sciences, Hull York Medical School, Kingston Upon Hull, East Riding of Yorkshire, UK,Department of Cardiology, Hull University Teaching Hospital Trust, Kingston Upon Hull, East Riding of Yorkshire, UK,Correspondence: Joseph J Cuthbert, Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston Upon Hull, HU16 5JQ, UK, Tel +44 1482 461776, Fax +44 1482 461779, Email
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Andrew L Clark
- Department of Cardiology, Hull University Teaching Hospital Trust, Kingston Upon Hull, East Riding of Yorkshire, UK
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5
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Miró Ò, Takagi K, Davison BA, Edwards C, Freund Y, Jacob J, Llorens P, Mebazaa A, Cotter G. Effect of systemic corticosteroid therapy for acute heart failure patients with elevated C-reactive protein. ESC Heart Fail 2022; 9:2225-2232. [PMID: 35393762 PMCID: PMC9288737 DOI: 10.1002/ehf2.13926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS The current study explores whether degree of inflammation, reflected by C-reactive protein (CRP) level, modifies the effect of intravenous (IV) corticosteroid administered in the emergency department (ED) on clinical outcomes in patients with acute heart failure (AHF). METHODS AND RESULTS We selected patients diagnosed with AHF in the ED, with confirmed N-terminal pro-B-type natriuretic peptide > 300 pg/mL and CRP > 5 mg/L in the ED from the Epidemiology of Acute Heart Failure in the Emergency Departments (EAHFE) registry. In these 1109 patients, 121 were treated by corticosteroid. The corticosteroid therapy hazard ratio (HR) for 30 day all-cause mortality was 1.26 [95% confidence interval (CI) 0.75-2.09, P = 0.38]. Although not statistically significant, HRs tended to decrease with increasing CRP level, with point estimates favouring corticosteroid at CRP levels above 20. In patients with CRP > 40 mg/L, with adjusted HRs of 0.56 (95% CI 0.20-1.55, P = 0.27) for 30 day all-cause mortality, 0.92 (95% CI 0.52-1.62, P = 0.78) for 30 day post-discharge ED revisit, hospitalization, or death, and adjusted odds ratio of 0.61 (95% CI 0.17-2.14, P = 0.44) for in-hospital all-cause mortality. CONCLUSIONS The present analysis suggests that corticosteroids might have the potential to improve outcomes in AHF patients with inflammatory activation. Larger, prospective studies of anti-inflammatory therapy should be considered to assess potential benefit in patients with the highest degree of inflammation.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Catalonia, Spain.,University of Barcelona, Barcelona, Catalonia, Spain
| | - Koji Takagi
- Momentum Research, Inc, Chapel Hill, NC, USA
| | - Beth A Davison
- Momentum Research, Inc, Chapel Hill, NC, USA.,Inserm U942 MASCOT, Paris, France
| | | | - Yonathan Freund
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux 18 de Paris (APHP), Sorbonne Université, Paris, France
| | - Javier Jacob
- University of Barcelona, Barcelona, Catalonia, Spain.,Emergency Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home, Hospital General de Alicante, Alicante, Spain.,Miguel Hernández University, Alicante, Spain
| | - Alexandre Mebazaa
- Inserm U942 MASCOT, Paris, France.,Department of Anesthesiology and Critical Care and Burn Unit, Hôpital Saint-Louis Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France
| | - Gad Cotter
- Momentum Research, Inc, Chapel Hill, NC, USA.,Inserm U942 MASCOT, Paris, France
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6
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Miró Ò, Llorens P, Freund Y, Davison B, Takagi K, Herrero-Puente P, Jacob J, Martín-Sánchez FJ, Gil V, Rosselló X, Alquézar-Arbé A, Jiménez-Fábrega FX, Masip J, Mebazaa A, Cotter G. Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry. Int J Cardiol 2021; 344:127-134. [PMID: 34543690 DOI: 10.1016/j.ijcard.2021.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Although recommended for the treatment of acute heart failure (AHF), the use of intravenous (IV) nitroglycerin (NTG) is supported by scarce and contradicting evidence. In the current analysis, we have assessed the impact of IV NTG administration by EMS or in emergency department (ED) on outcomes of AHF patients. METHODS We analyze AHF patients included by 45 hospitals that were delivered to ED by EMS. Patients were grouped according to whether treatment with IV NTG was started by EMS before ED admission (preED-NTG), during the ED stay (ED-NTG) or were untreated with IV NTG (no-NTG, control group). In-hospital, 30-day and 365-day all-cause mortality, prolonged hospitalization (>7 days) and 90-day post-discharge combined adverse events (ED revisit, hospitalization or death) were compared in EMS-NTG and ED-NTG respect to control group. RESULTS We included 8424 patients: preED-NTG = 292 (3.5%), ED-NTG = 1159 (13.8%) and no-NTG = 6973 (82.7%). preED-NTG group had the most severely decompensated cases of AHF (p < 0.001) but it had lower in-hospital (OR = 0.724, 95%CI = 0.459-1.114), 30-day (HR = 0.818, 0.576-1.163) and 365-day mortality (HR = 0.692, 0.551-0.869) and 90-day post-discharge events (HR = 0.795, 0.643-0.984) than control group. ED-NTG group had mortalities similar to control group (in-hospital: OR = 1.164, 0.936-1.448; 30-day: HR = 0.980, 0.819-1.174; 365-day: HR = 0.929, 0.830-1.039) but significantly decreased 90-day post-discharge events (HR = 0.870, 0.780-0.970). Prolonged hospitalization rate did not differ among groups. Five different analyses confirmed these findings. CONCLUSIONS Early prehospital IV NTG administration was associated with lower mortality and post-discharge events, while IV NTG initiated in ED only improved post-discharge event rate. Further studies are needed to assess the role of early prehospital administration of IV NTG to patients with AHF.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; The GREAT (Global Research in Acute Contditions Team) Network, Via Antonio Serra 54, 00191, Roma, Italy.
| | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Spain
| | - Yonathan Freund
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux 18 de Paris (APHP), Sorbonne Université, Paris, France
| | - Beth Davison
- Momentum Research, Inc., Durham, NC, USA; INSERM U-942 (Biotherapy in the critically ill), Paris, France
| | - Koji Takagi
- Momentum Research, Inc., Durham, NC, USA; INSERM U-942 (Biotherapy in the critically ill), Paris, France
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Xavier Rosselló
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | | | - Josep Masip
- Consultant Research Direction, University of Barcelona, Catalonia, Spain
| | - Alexandre Mebazaa
- The GREAT (Global Research in Acute Contditions Team) Network, Via Antonio Serra 54, 00191, Roma, Italy; INSERM U-942 (Biotherapy in the critically ill), Paris, France; Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
| | - Gad Cotter
- Momentum Research, Inc., Durham, NC, USA; INSERM U-942 (Biotherapy in the critically ill), Paris, France
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7
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Ehteshami-Afshar S, Mooney L, Dewan P, Desai AS, Lang NN, Lefkowitz MP, Petrie MC, Rizkala AR, Rouleau JL, Solomon SD, Swedberg K, Shi VC, Zile MR, Packer M, McMurray JJV, Jhund PS, Hawkins NM. Clinical Characteristics and Outcomes of Patients With Heart Failure With Reduced Ejection Fraction and Chronic Obstructive Pulmonary Disease: Insights From PARADIGM-HF. J Am Heart Assoc 2021; 10:e019238. [PMID: 33522249 PMCID: PMC7955331 DOI: 10.1161/jaha.120.019238] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a common comorbidity in heart failure with reduced ejection fraction, associated with undertreatment and worse outcomes. New treatments for heart failure with reduced ejection fraction may be particularly important in patients with concomitant COPD. Methods and Results We examined outcomes in 8399 patients with heart failure with reduced ejection fraction, according to COPD status, in the PARADIGM‐HF (Prospective Comparison of Angiotensin Receptor Blocker–Neprilysin Inhibitor With Angiotensin‐Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial. Cox regression models were used to compare COPD versus non‐COPD subgroups and the effects of sacubitril/valsartan versus enalapril. Patients with COPD (n=1080, 12.9%) were older than patients without COPD (mean 67 versus 63 years; P<0.001), with similar left ventricular ejection fraction (29.9% versus 29.4%), but higher NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; median, 1741 pg/mL versus 1591 pg/mL; P=0.01), worse functional class (New York Heart Association III/IV 37% versus 23%; P<0.001) and Kansas City Cardiomyopathy Questionnaire–Clinical Summary Score (73 versus 81; P<0.001), and more congestion and comorbidity. Medical therapy was similar in patients with and without COPD except for beta‐blockade (87% versus 94%; P<0.001) and diuretics (85% versus 80%; P<0.001). After multivariable adjustment, COPD was associated with higher risks of heart failure hospitalization (hazard ratio [HR], 1.32; 95% CI, 1.13–1.54), and the composite of cardiovascular death or heart failure hospitalization (HR, 1.18; 95% CI, 1.05–1.34), but not cardiovascular death (HR, 1.10; 95% CI, 0.94–1.30), or all‐cause mortality (HR, 1.14; 95% CI, 0.99–1.31). COPD was also associated with higher risk of all cardiovascular hospitalization (HR, 1.17; 95% CI, 1.05–1.31) and noncardiovascular hospitalization (HR, 1.45; 95% CI, 1.29–1.64). The benefit of sacubitril/valsartan over enalapril was consistent in patients with and without COPD for all end points. Conclusions In PARADIGM‐HF, COPD was associated with lower use of beta‐blockers and worse health status and was an independent predictor of cardiovascular and noncardiovascular hospitalization. Sacubitril/valsartan was beneficial in this high‐risk subgroup. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01035255.
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Affiliation(s)
| | - Leanne Mooney
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Pooja Dewan
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Akshay S Desai
- Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA
| | - Ninian N Lang
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
| | | | - Mark C Petrie
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
| | | | - Jean L Rouleau
- Institut de Cardiologie Université de Montréal Montréal Québec Canada
| | - Scott D Solomon
- Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA
| | | | - Victor C Shi
- Novartis Pharmaceutical Corporation East Hanover NJ
| | - Michael R Zile
- Department of Medicine Medical University of South Carolina Charleston SC
| | - Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical CenterImperial College Dallas TX USA.,Imperial College London UK
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
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8
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Xu S, Ye Z, Ma J, Yuan T. The impact of chronic obstructive pulmonary disease on hospitalization and mortality in patients with heart failure. Eur J Clin Invest 2021; 51:e13402. [PMID: 32916000 DOI: 10.1111/eci.13402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several studies have suggested that chronic obstructive pulmonary disease (COPD) could be predictive of the prognosis in patients with heart failure (HF), but yield conflicting findings. Therefore, we conducted a meta-analysis to examine the impact of COPD on adverse outcomes in patients with HF. METHODS We systematically searched the databases of PubMed, EMBASE, Google Scholar, Cochrane library from inception to August 2020 for the relevant studies. Adjusted risk ratios (RRs) and confidence intervals (CIs) were collected and then pooled by the Review Manager version 5.30 software with a random-effects model. RESULTS A total of 18 studies (6 post hoc analyses of trials and 12 observational studies) were included in this meta-analysis. COPD was associated with an increased risk of all-cause mortality (hospitalized HF: RR 1.43, 95% CI: 1.20-1.70; chronic HF: RR 1.24, 95% CI: 1.16-1.33), but not cardiovascular mortality, in patients with hospitalized HF or chronic HF. In addition, COPD was associated with increased risks of all-cause hospitalization (RR 1.31, 95% CI: 1.21-1.42) and HF hospitalization (RR 1.31, 95% CI: 1.21-1.42) in the chronic HF patients. CONCLUSIONS COPD comorbidity could increase the risk of all-cause mortality of HF patients. Future research should confirm the findings on hospitalization because of the limited studies included for this outcome.
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Affiliation(s)
- Shuo Xu
- Department of Respiratory and Critical Care Medicine, the Ganzhou people's Hospital, Ganzhou of Jiangxi, Ganzhou, China
| | - Zi Ye
- St Vincent Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Taiwen Yuan
- Department of Respiratory and Critical Care Medicine, the Ganzhou people's Hospital, Ganzhou of Jiangxi, Ganzhou, China
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9
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Pellicori P, Cleland JGF, Clark AL. Chronic Obstructive Pulmonary Disease and Heart Failure: A Breathless Conspiracy. Heart Fail Clin 2020; 16:33-44. [PMID: 31735313 DOI: 10.1016/j.hfc.2019.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are both common causes of breathlessness and often conspire to confound accurate diagnosis and optimal therapy. Risk factors (such as aging, smoking, and obesity) and clinical presentation (eg, cough and breathlessness on exertion) can be very similar, but the treatment and prognostic implications are very different. This review discusses the diagnostic challenges in individuals with exertional dyspnea. Also highlighted are the prevalence, clinical relevance, and therapeutic implications of a concurrent diagnosis of COPD and HF.
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Affiliation(s)
- Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK.
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull HU16 5JQ, UK
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10
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Correale M, Paolillo S, Mercurio V, Limongelli G, Barillà F, Ruocco G, Palazzuoli A, Scrutinio D, Lagioia R, Lombardi C, Lupi L, Magrì D, Masarone D, Pacileo G, Scicchitano P, Matteo Ciccone M, Parati G, Tocchetti CG, Nodari S. Comorbidities in chronic heart failure: An update from Italian Society of Cardiology (SIC) Working Group on Heart Failure. Eur J Intern Med 2020; 71:23-31. [PMID: 31708358 DOI: 10.1016/j.ejim.2019.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/27/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Abstract
The increasing number of patients with heart failure HF and comorbidities is due to aging population and increase of life expectancy of patients with cardiovascular disease. Encouraging results derived by recent trials may suggest some comorbidities as new targets for new drugs, highlighting the need for a better understanding of the comorbidities' effects in HF patients and the need of a multidisciplinary approach for the management of chronic HF with comorbidities. We report a brief review about main cardiovascular and non-cardiovascular comorbidities in HF patients in order to update physicians and researchers engaged in the HF research or in "fight against heart failure."
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Affiliation(s)
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe Limongelli
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy; Department of Translational Medical Sciences, Luigi Vanvitelli University, Naples, Italy; Institute of Cardiovascular Sciences, University College of London, London, United Kingdom
| | - Francesco Barillà
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza" University of Rome, Italy
| | - Gaetano Ruocco
- Cardiovascular Diseases Unit Department of Internal Medicine, University of Siena, Siena, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit Department of Internal Medicine, University of Siena, Siena, Italy
| | | | - Rocco Lagioia
- Cardiology Department, IRCCS "S. Maugeri" Cassano (BA), Bari, Italy
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences. San Luca Hospital, Milan, Italy
| | - Laura Lupi
- Section of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, University "La Sapienza", Rome, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Pietro Scicchitano
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari "A. Moro", Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari "A. Moro", Bari, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences. San Luca Hospital, Milan, Italy
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Savina Nodari
- Section of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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11
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Gimeno-Miguel A, Gracia Gutiérrez A, Poblador-Plou B, Coscollar-Santaliestra C, Pérez-Calvo JI, Divo MJ, Calderón-Larrañaga A, Prados-Torres A, Ruiz-Laiglesia FJ. Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records. BMJ Open 2019; 9:e033174. [PMID: 31874886 PMCID: PMC7008407 DOI: 10.1136/bmjopen-2019-033174] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of hospitalisation and mortality. DESIGN Observational retrospective population study based on electronic health records. SETTING EpiChron Cohort (Aragón, Spain). PARTICIPANTS All the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients' electronic health records until 31 December 2011. PRIMARY OUTCOME We performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality. RESULTS Almost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality. CONCLUSIONS Multimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.
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Affiliation(s)
- Antonio Gimeno-Miguel
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Anyuli Gracia Gutiérrez
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Carlos Coscollar-Santaliestra
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- Primary Care Health Centre San Pablo, SALUD, Zaragoza, Spain
| | - J Ignacio Pérez-Calvo
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
- University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Miguel J Divo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Alexandra Prados-Torres
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Fernando J Ruiz-Laiglesia
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
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12
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Miró Ò, Takagi K, Gayat E, Llorens P, Martín-Sánchez FJ, Jacob J, Herrero-Puente P, Gil V, Wussler DN, Richard F, López-Grima ML, Gil C, Garrido JM, Pérez-Durá MJ, Alquézar A, Alonso H, Tost J, Lucas Invernón FJ, Mueller C, Mebazaa A. CORT-AHF Study: Effect on Outcomes of Systemic Corticosteroid Therapy During Early Management Acute Heart Failure. JACC-HEART FAILURE 2019; 7:834-845. [PMID: 31521676 DOI: 10.1016/j.jchf.2019.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study investigated whether systemic corticosteroids (new onset) administered to patients with acute heart failure (AHF) have any association with outcomes, with differentiated analyses for patients with and without chronic obstructive pulmonary disease (COPD) as a comorbidity. BACKGROUND Patients with undiagnosed dyspnea frequently receive corticosteroids in emergency departments while determining a final diagnosis, but their effect on the outcomes of patients with AHF without overt COPD exacerbation is unknown. METHODS We selected patients with AHF from the EAHFE (Epidemiology of Acute Heart Failure in the Emergency Departments) registry, recording key data (new-onset corticosteroid therapy, COPD condition). Patients with and without COPD were analyzed separately. We calculated unadjusted and adjusted ratios for corticosteroid-treated compared with corticosteroid-untreated patients for 2 coprimary endpoints: 90-day all-cause mortality (from index episode) and 90-day post-discharge combined endpoint (all-cause mortality or readmission for AHF), with intermediate time-point estimations. Other secondary endpoints were calculated, and some sensitive and stratified analyses were performed. RESULTS We analyzed 11,356 patients: 8,635 without COPD (841 corticosteroid-treated, 9.7%) and 2,721 with COPD (753 corticosteroid-treated, 27.7%). There were several differences between treated and untreated patients, essentially because corticosteroid-treated patients were sicker. Although unadjusted outcomes were worse in corticosteroid-treated patients, especially in patients without COPD, these differences disappeared after adjustment: hazard ratios for 90-day mortality (without/with COPD) were 0.91 (95% confidence interval (CI): 0.76 to 1.10)/0.99 (95% CI: 0.78 to 1.26), and 1.09 (95% CI: 0.93 to 1.28)/1.02 (95% CI: 0.86 to 1.21) for the post-discharge combined endpoint. Analyses of intermediate time-point coprimary endpoints and secondary outcomes rendered similar estimations. Sensitivity and stratified analysis did not significantly modify these results. CONCLUSIONS There is no evidence of harm related to the new onset of systemic corticosteroid therapy during an episode of AHF, either in patients with or without concomitant COPD.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Catalonia, Spain, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Koji Takagi
- Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan; INSERM UMR-S 942, Paris, France
| | - Etienne Gayat
- INSERM UMR-S 942, Paris, France; Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
| | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Alicante, Spain
| | - Francisco J Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
| | | | - Víctor Gil
- Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Catalonia, Spain, University of Barcelona, Barcelona, Catalonia, Spain
| | - Desiree N Wussler
- Cardiology Department, University Hospital Basel, Basel, Switzerland
| | - Fernando Richard
- Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Cristina Gil
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - José M Garrido
- Emergency Department, Hospital Virgen de la Macarena, Seville, Spain
| | | | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
| | - Héctor Alonso
- Emergency Department, Hospital Marqués de Valdecilla, Santander, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Catalonia, Spain
| | | | - Christian Mueller
- Cardiology Department, University Hospital Basel, Basel, Switzerland
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Paris, France; Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
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13
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Gulea C, Zakeri R, Quint JK. Impact of chronic obstructive pulmonary disease on readmission after hospitalization for acute heart failure: A nationally representative US cohort study. Int J Cardiol 2019; 290:113-118. [DOI: 10.1016/j.ijcard.2019.04.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/09/2019] [Accepted: 04/28/2019] [Indexed: 01/03/2023]
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14
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Scrutinio D, Guida P, Passantino A, Ammirati E, Oliva F, Lagioia R, Raimondo R, Venezia M, Frigerio M. Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival. Eur J Intern Med 2019; 60:31-38. [PMID: 30446355 DOI: 10.1016/j.ejim.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of β-blockers at discharge and mortality in patients with COPD. METHODS We studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality. RESULTS After adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06-1.47; p = .007). The relative risk of death for COPD patients increased steeply from 30 to 180 days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of β-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53-0.83; p ≤.001). CONCLUSIONS Our data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of β-blockers at discharge is independently associated with improved survival in ADHF patients with COPD.
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Affiliation(s)
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | | | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Rocco Lagioia
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | - Mario Venezia
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | - Maria Frigerio
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
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15
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Breathlessness, but not cough, suggests chronic obstructive pulmonary disease in elderly smokers with stable heart failure. Multidiscip Respir Med 2018; 13:35. [PMID: 30305900 PMCID: PMC6166269 DOI: 10.1186/s40248-018-0148-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/20/2018] [Indexed: 12/28/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common comorbidity of heart failure (HF), but remains often undiagnosed, and we aimed to identify symptoms predicting COPD in HF. As part of an observational, prospective study, we investigated stable smokers with a confirmed diagnosis of HF, using the 8-item COPD-Assessment-Test (CAT) questionnaire to assess symptoms. All the items were correlated with the presence of COPD, and logistic regression models were used to identify independent predictors. 96 HF patients were included, aged 74, 33% with COPD. Patients with HF and COPD were more symptomatic, but only breathlessness when walking up a hill was an independent predictor of COPD (odds ratio = 1.33, p = 0.0484). Interestingly, COPD-specific symptoms such as cough and phlegm were not significant. Thus, in elderly smokers with stable HF, significant breathlessness when walking up a hill is most indicative of associated COPD, and may indicate the need for further lung function evaluation.
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16
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Cuthbert JJ, Kearsley JW, Kazmi S, Kallvikbakka-Bennett A, Weston J, Davis J, Rimmer S, Clark AL. The impact of heart failure and chronic obstructive pulmonary disease on mortality in patients presenting with breathlessness. Clin Res Cardiol 2018; 108:185-193. [PMID: 30091083 PMCID: PMC6510798 DOI: 10.1007/s00392-018-1342-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/18/2018] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Joseph J Cuthbert
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
| | - Joshua W Kearsley
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
| | - Syed Kazmi
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
| | - Anna Kallvikbakka-Bennett
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
| | - Joan Weston
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
| | - Julie Davis
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
| | - Stella Rimmer
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
| | - Andrew L Clark
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
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17
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Londoño KL, Formiga F, Chivite D, Moreno-Gonzalez R, Migone De Amicis M, Corbella X. Prognostic influence of prior chronic obstructive pulmonary disease in patients admitted for their first episode of acute heart failure. Intern Emerg Med 2018; 13:351-357. [PMID: 29508227 DOI: 10.1007/s11739-018-1820-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 03/01/2018] [Indexed: 01/01/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in heart failure (HF) patients. Whether a prior COPD diagnosis influences patients' prognosis in early stages of HF is unknown. We reviewed patients > 50 years old admitted because of a first episode of acute HF. We divided the sample into two groups according to the existence of a prior diagnosis of COPD. We used regression analysis to identify the baseline patients' characteristics associated with the presence of COPD, and Cox mortality analysis to identify baseline and discharge data related to higher risk of a combined outcome of 1-year all-cause readmission or mortality. Finally, 985 patients were included in the analysis; 212 (21.5%) with a prior diagnosis of COPD. Baseline characteristics were similar between both groups except for a much higher prevalence of male gender, higher number of chronic therapies, and lower prevalence of atrial fibrillation among COPD patients. The combined primary outcome is significantly more prevalent in COPD patients (68.4 vs. 59.8%, p = 0.022). Cox analysis identified this prior diagnosis of COPD (HR 1.282, 95% CI 1.063-1.547; p = 0.001) as an independent risk factor for 1-year readmission and mortality, together with older age, higher admission creatinine and potassium values, and a higher number of chronic therapies. Our study confirms that in a "real-life" cohort of elderly patients experiencing a first episode of acute HF, the presence of a prior diagnosis of COPD is common, and confers a higher risk of adverse outcomes (death or readmission) during the year following discharge.
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Affiliation(s)
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, L' Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - David Chivite
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, L' Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Rafael Moreno-Gonzalez
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, L' Hospitalet de Llobregat, 08907, Barcelona, Spain
| | | | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, L' Hospitalet de Llobregat, 08907, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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18
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Canepa M, Straburzynska-Migaj E, Drozdz J, Fernandez-Vivancos C, Pinilla JMG, Nyolczas N, Temporelli PL, Mebazaa A, Lainscak M, Laroche C, Maggioni AP, Piepoli MF, Coats AJS, Ferrari R, Tavazzi L. Characteristics, treatments and 1-year prognosis of hospitalized and ambulatory heart failure patients with chronic obstructive pulmonary disease in the European Society of Cardiology Heart Failure Long-Term Registry. Eur J Heart Fail 2017; 20:100-110. [PMID: 28949063 DOI: 10.1002/ejhf.964] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/10/2017] [Accepted: 07/24/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS To describe the characteristics and assess the 1-year outcomes of hospitalized (HHF) and chronic (CHF) heart failure patients with chronic obstructive pulmonary disease (COPD) enrolled in a large European registry between May 2011 and April 2013. METHODS AND RESULTS Overall, 1334/6920 (19.3%) HHF patients and 1322/9409 (14.1%) CHF patients were diagnosed with COPD. In both groups, patients with COPD were older, more frequently men, had a worse clinical presentation and a higher prevalence of co-morbidities. In HHF, the increase in the use of heart failure (HF) medications at hospital discharge was greater in non-COPD than in COPD for angiotensin-converting enzyme inhibitors (+13.7% vs. +7.2%), beta-blockers (+20.6% vs. +11.8%) and mineralocorticoid receptor antagonists (+20.9% vs. +17.3%), thus widening the gap in HF treatment already existing between the two groups at admission. In CHF patients, there was a similar increase in the use of these medications after enrollment visit in the two groups, leaving a significant difference of 8.2% for beta-blockers in favour of non-COPD patients (89.8% vs. 81.6%, P < 0.001). At 1-year follow-up, the hazard ratios for COPD in multivariable analysis confirmed its independent association with hospitalizations both in HHF [all-cause: 1.16 (1.04-1.29), for HF: 1.22 (1.05-1.42)] and CHF patients [all-cause: 1.26 (1.13-1.41), for HF: 1.37 (1.17-1.60)]. The association between COPD and all-cause mortality was not confirmed in both groups after adjustments. CONCLUSIONS COPD frequently coexists in HHF and CHF, worsens the clinical course of the disease, and significantly impacts its therapeutic management and prognosis. The matter should deserve greater attention from the cardiology community.
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Affiliation(s)
- Marco Canepa
- Cardiology Unit, Department of Internal Medicine, University of Genoa, and Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | - Jose Manuel Garcia Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatias Familiars, U.G.C. de Cardiologia y Cirugia Cardiovascular, Ibima, Malaga, Spain
| | - Noemi Nyolczas
- Military Hospital, State Health Centre, Budapest, Hungary
| | | | - Alexandre Mebazaa
- University Paris 7, Assistance Publique-Hôpitaux de Paris, U942 Inserm, Paris, France
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | | | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, AUSL Piacenza, Italy
| | - Andrew J S Coats
- Monash University, Australia and University of Warwick, Coventry, UK
| | - Roberto Ferrari
- Centro Cardiologico Universitario e LTTA Centre, University of Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research - E.S. Health Science Foundation, Cotignola (RA), Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research - E.S. Health Science Foundation, Cotignola (RA), Italy
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