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Zhang T, Wang X, Zhang Y, Feng T, Zhou Y, Zhao L. Early β-blocker use and in-hospital outcomes in patients with chronic obstructive pulmonary disease hospitalized with acute coronary syndrome: findings from the CCC-ACS project. Front Cardiovasc Med 2024; 11:1385943. [PMID: 39055663 PMCID: PMC11269115 DOI: 10.3389/fcvm.2024.1385943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) after acute coronary artery syndrome (ACS) are at an increased risk of heart failure and death. However, β-blockers have been underused in this population group due to concerns of adverse reactions. Objective This study aims to investigate the β-blocker prescription at admission and its impact on the in-hospital outcomes in patients with COPD after ACS in a Chinese national cohort. Methods Among 113,650 patients with ACS enrolled in the national registry of the Improving Care for Cardiovascular Disease in China between November 2014 and July 2019, a total of 1,084 ACS patients with COPD were included in this study. The primary endpoint was in-hospital mortality, and the secondary endpoint was the composite of in-hospital all-cause death and heart failure. Results Early oral β-blocker therapy was administered to 49.8% of patients. The Kaplan-Meier analysis showed that the early β-blocker treatment group had lower all-cause mortality (0.9% vs. 2.9%; P < 0.05) and lower combined endpoint event rate (8.2% vs. 12.0%; P < 0.05) compared to the those of the non-early β-blocker treatment group. The analysis of inverse probability of treatment weighting showed that the early β-blocker treatment group was associated with a significantly reduced incidence of all-cause death (risk ratio, 0.332, 0.119-0.923, P = 0.035), heart failure (risk ratio, 0.625, 95% CI 0.414-0.943, P = 0.025), and combined endpoint events (risk ratio: 0.616, 95% CI: 0.418-0.908, P = 0.014). In the subgroup of patients over 70 years of age, the corresponding hazard ratio was 0.268 (95% CI 0.077-0.938) for all-cause mortality and 0.504 (95% CI 0.316-0.805) for combined endpoint events. Conclusion β-blockers have been underused in patients with COPD and ACS in China. Early β-blocker therapy is associated with an improvement in in-hospital outcomes in patients with COPD after ACS. Clinical Trial Registration ClinicalTrials.gov, identifier (NCT02306616).
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Affiliation(s)
- Tao Zhang
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Wang
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yucheng Zhang
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tingting Feng
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lin Zhao
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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LI FR, WANG S, LI X, CHENG ZY, JIN C, MO CB, ZHENG J, LIANG FC, GU DF. Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen, China. J Geriatr Cardiol 2024; 21:81-89. [PMID: 38440336 PMCID: PMC10908585 DOI: 10.26599/1671-5411.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease (CHD) is insufficient. We aimed to assess the association and population-attributable fractions (PAFs) between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen, China. METHODS We conducted a retrospective cohort study of older Chinese patients (aged ≥ 65 years) who were diagnosed with CHD. Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease (CVD) mortality. We also calculated the PAFs. RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1, 2016, and August 31, 2022. Among them, 70,217 (91.9%) had multimorbidity, defined as the presence of at least one of the predefined 14 chronic conditions. Those with cancer, hemorrhagic stroke and chronic liver disease had the worst overall death risk, with adjusted HRs (95% CIs) of 4.05 (3.77, 4.38), 2.22 (1.94, 2.53), and 1.85 (1.63, 2.11), respectively. For CVD mortality, the highest risk was observed for hemorrhagic stroke, ischemic stroke, and chronic kidney disease; the corresponding adjusted HRs (95% CIs) were 3.24 (2.77, 3.79), 1.91 (1.79, 2.04), and 1.81 (1.64, 1.99), respectively. All-cause mortality was mostly attributable to cancer, heart failure and ischemic stroke, with PAFs of 11.8, 10.2, and 9.1, respectively. As for CVD mortality, the leading PAFs were heart failure, ischemic stroke and diabetes; the corresponding PAFs were 18.0, 15.7, and 6.1, respectively. CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen, China. Cancer, heart failure, ischemic stroke and diabetes are the primary contributors to PAFs. Therefore, prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.
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Affiliation(s)
- Fu-Rong LI
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shuang WANG
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Xia LI
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Zhi-Yuan CHENG
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Cheng JIN
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Chun-Bao MO
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Jing ZHENG
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Feng-Chao LIANG
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Dong-Feng GU
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
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Zheng Y, Hu Z, Seery S, Li C, Yang J, Wang W, Qi Y, Shao C, Fu Y, Xiao H, Tang YD. Global Insights into Chronic Obstructive Pulmonary Disease and Coronary Artery Disease: A Systematic Review and Meta-Analysis of 6,400,000 Patients. Rev Cardiovasc Med 2024; 25:25. [PMID: 39077650 PMCID: PMC11262403 DOI: 10.31083/j.rcm2501025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/13/2023] [Accepted: 08/24/2023] [Indexed: 07/31/2024] Open
Abstract
Background The high prevalence of chronic obstructive pulmonary disease (COPD) in coronary artery disease (CAD) has been acknowledged over the past decade, although the cause/s remain uncertain due to differences in diagnoses. COPD has also become a leading CAD comorbidity, although again little is known about its interactions. This meta-analysis explored COPD prevalence in the global CAD population, as well as the influence of COPD on CAD. Methods PubMed, Web of Science, Embase, and grey literature were searched until 26th November 2021. The prevalence of COPD was calculated, and data were grouped according to COPD diagnostic methods, interventions, region, economic status, etc. Outcomes including all-cause death, cardiac death, myocardial infarction, revascularization, stroke, heart failure, and respiratory failure were analyzed. This study was registered with PROSPERO (CRD No.42021293270). Results There was an average prevalence of 14.2% for COPD in CAD patients (95% CI: 13.3-15.1), with diagnostics of COPD through spirometry, International Classification of the Diseases (ICD codes), and self-reported methods. Comorbid COPD-CAD patients were more likely to be smokers and suffer from cardiovascular and respiratory complications (all odds ratios [OR] > 1). COPD-CAD has higher mortality (hazard ratio [HR] 2.81, 95% CI: 2.40-3.29), and myocardial infarction, stroke, and respiratory failure rates (all HR > 1). Coronary artery bypass graft (CABG) reduces the need for revascularization (HR 0.43, 95% CI: 0.20-0.94) compared to percutaneous coronary intervention (PCI), without increasing mortality. Conclusions The global prevalence of COPD is particularly high in CAD patients. COPD-CAD patients are more likely to encounter cardiovascular and respiratory complications and endure poorer outcomes. Limited evidence suggests that CABG may reduce the need for revascularization without increasing mortality, although further research is required to confirm these observations.
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Affiliation(s)
- Yitian Zheng
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, 100021 Beijing, China
| | - Zhenliang Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100005 Beijing, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Science & Peking Union Medical College, 100005 Beijing, China
- Faculty of Health and Medicine, Division of Health Research, Lancaster University, LA1 4YW Lancaster, UK
| | - Chen Li
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China
| | - Jie Yang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China
| | - Wenyao Wang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China
| | - Yu Qi
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China
| | - Chunli Shao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China
| | - Yi Fu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 100191 Beijing, China
| | - Han Xiao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, 100021 Beijing, China
| | - Yi-Da Tang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, 100021 Beijing, China
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Calderón Montero A. [Cardiopulmonary axis and cardiovascular mortality in patients with COPD]. Semergen 2023; 49:101928. [PMID: 36796228 DOI: 10.1016/j.semerg.2023.101928] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 02/16/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality in our environment and was usually considered to be confined to the lung territory. The latest studies suggest that it is a systemic disease whose most probable etiopathogenesis is a state of low-intensity chronic inflammation that worsens during exacerbations. And recent scientific evidence has highlighted that cardiovascular diseases are one of the main causes of hospitalization and mortality in these patients. This relationship must be understood considering that both systems, the pulmonary and the cardiovascular, are closely related constituting the cardiopulmonary axis. Therefore, the therapeutic approach to COPD should not only include the treatment of respiratory complications, but also the prevention and treatment of cardiovascular diseases, which are very common in these patients. In this sense, in the last years, studies have been carried out that analyze the effect of the different types of inhaled therapy on all-cause mortality and cardiovascular mortality in particular.
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Ruzieh M, Baugh AD, Al Jebbawi L, Edwards ES, Jia KQ, Dransfield MT, Foy AJ. Beta-blocker use in patients with chronic obstructive pulmonary disease: A systematic review: A systematic review of βB in COPD. Trends Cardiovasc Med 2023; 33:53-61. [PMID: 34856338 DOI: 10.1016/j.tcm.2021.11.004] [Citation(s) in RCA: 1] [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: 09/23/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 02/01/2023]
Abstract
Beta-blockers (βB) are a frequently used class of medications. Although βB have many indications, those related to cardiovascular disease are among the most common and important. However, in patients with chronic obstructive pulmonary disease (COPD), βB are used less often due to concerns about an unfavorable impact on respiratory morbidity and mortality. We performed a systematic review to assess the safety of βB in patients with COPD. We included a total of 2 randomized controlled trials and 28 observational studies. The majority found statistically significant reductions in mortality. The two higher quality observational studies reported increased mortality with βB. The risk of COPD exacerbations was reduced in about half of the studies. Nonetheless, there were significant biases that confounded the results. The highest quality RCT found a significant increase in severe and very severe COPD exacerbations with βB use. In conclusion, data on the safety of βB in patients with COPD are conflicting. However, given higher quality evidence showed harm with their use, βB should be prescribed with caution in patients with COPD, including patients with cardiac indication for βB.
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Affiliation(s)
- Mohammed Ruzieh
- Division of Cardiovascular Medicine. University of Florida, Gainesville, FL.
| | - Aaron D Baugh
- Pulmonary, Critical Care, Allergy, and Sleep Medicine. University of California San Francisco, San Francisco, CA
| | - Lama Al Jebbawi
- Department of Internal Medicine. Henry Ford Allegiance Health Affiliation, Jackson, MI
| | - Emily S Edwards
- Department of Internal Medicine. University of Florida, Gainesville, FL
| | - Kelly Qi Jia
- Penn State Heart and Vascular Institute. Penn State College of Medicine, Hershey, PA
| | - Mark T Dransfield
- Pulmonary, Allergy, and Critical Care Medicine. University of Alabama at Birmingham, Birmingham, AL
| | - Andrew J Foy
- Penn State Heart and Vascular Institute. Penn State College of Medicine, Hershey, PA
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Grebe J, Müller T, Altiok E, Becker M, Keszei AP, Marx N, Dreher M, Daher A. Effects of COPD on Left Ventricular and Left Atrial Deformation in Patients with Acute Myocardial Infarction: Strain Analysis Using Speckle-Tracking Echocardiography. J Clin Med 2022; 11:jcm11071917. [PMID: 35407524 PMCID: PMC8999583 DOI: 10.3390/jcm11071917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Myocardial strain analysis, which describes myocardial deformation (shortening or lengthening), provides more detailed information about left ventricular (LV) and atrial (LA) functions than conventional echocardiography and delivers prognostic information. To analyze the effects of COPD on left heart function upon acute myocardial infarction (AMI), consecutive AMI patients were retrospectively screened, and patients were included if a post-AMI echocardiography and results of recent pulmonary function tests (PFTs) were available. Strain analysis was performed by a cardiologist who was blinded to clinical information. Overall, 109 AMI patients were included (STEMI: 38%, non-STEMI: 62%). COPD patients (41%) had significantly more impaired LV “global-longitudinal-strain” (LV-GLS) compared to non-COPD patients (−15 ± 4% vs. −18 ± 4%; p < 0.001, respectively), even after adjusting for LV-ejection-fraction (LVEF) and age (mean estimated difference: 1.7%, p = 0.009). Furthermore, COPD patients had more impaired LA strain (LAS) than non-COPD patients in all cardiac cycle phases (estimated mean differences after adjusting for LVEF and age: during reservoir phase: −7.5% (p < 0.001); conduit phase: 5.5% (p < 0.001); contraction phase: 1.9% (p = 0.034)). There were no correlations between PFT variables and strain values. In conclusion, the presence of COPD was associated with more impaired LV and LA functions after AMI, as detected by strain analysis, which was independent of age, LVEF, and PFT variables.
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Affiliation(s)
- Julian Grebe
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (J.G.); (E.A.); (M.B.); (N.M.)
| | - Tobias Müller
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (T.M.); (M.D.)
| | - Ertunc Altiok
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (J.G.); (E.A.); (M.B.); (N.M.)
| | - Michael Becker
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (J.G.); (E.A.); (M.B.); (N.M.)
- Department of Cardiology, Nephrology and Intensive Care Medicine, Rhein-Maas Hospital, 52146 Wuerselen, Germany
| | - András P. Keszei
- Center for Translational & Clinical Research Aachen (CTC-A), University Hospital RWTH, 52074 Aachen, Germany;
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (J.G.); (E.A.); (M.B.); (N.M.)
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (T.M.); (M.D.)
| | - Ayham Daher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (T.M.); (M.D.)
- Correspondence:
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Karoli NA, Rebrov AP. [Possibilities and limitations of the use of beta-blockers in patients with cardiovascular disease and chronic obstructive pulmonary disease]. KARDIOLOGIIA 2021; 61:89-98. [PMID: 34763643 DOI: 10.18087/cardio.2021.10.n1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/29/2020] [Indexed: 06/13/2023]
Abstract
In medical literature, increasing attention is paid to comorbidities in patients with chronic obstructive pulmonary disease (COPD). In clinical practice, physicians often hesitate to prescribe beta-blockers (β1-adrenoblockers) to COPD patients. This article summarized new results of using beta-blockers in patients with COPD. According to reports, the selective β1-blocker treatment considerably increases the survival rate of patients with COPD and ischemic heart disease, particularly after myocardial infarction (MI), and with chronic heart failure (CHF). The benefit of administering selective β1-blockers to patients with CHF and/or a history of MI overweighs a potential risk related with the treatment even in patients with severe COPD. Convincing data in favor of the β1-blocker treatment in COPD patients without the above-mentioned comorbidities are not available. At present, the selective β1-blocker treatment is considered safe for patients with cardiovascular diseases and COPD. For this reason, selective β1-blockers, such as bisoprolol, metoprolol or nebivolol can be used in managing this patient cohort. Nonselective β1-blockers may induce bronchospasm and are not recommended for COPD patients. For the treatment with β-blockers with intrinsic sympathomimetic activity, the probability of bronchial obstruction in COPD patients is lower; however, drugs of this pharmaceutical group have not been compared with cardioselective beta-blockers. For safety reasons, the beta-blocker treatment should be started outside exacerbation of COPD and from a small dose. Careful monitoring is recommended for possible new symptoms, such as emergence/increase of shortness of breath, cough or changes in dosing of other drugs (for example, increased frequency of using short-acting bronchodilators).
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Affiliation(s)
- N A Karoli
- Saratov State Medical University Saratov, Russia
| | - A P Rebrov
- Saratov State Medical University Saratov, Russia
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Kubota Y, Tay WT, Teng THK, Asai K, Noda T, Kusano K, Suzuki A, Hagiwara N, Hisatake S, Ikeda T, Yasuoka R, Kurita T, Shimizu W. Impact of beta-blocker use on the long-term outcomes of heart failure patients with chronic obstructive pulmonary disease. ESC Heart Fail 2021; 8:3791-3799. [PMID: 34189870 PMCID: PMC8497364 DOI: 10.1002/ehf2.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 05/03/2021] [Accepted: 06/08/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS The number of patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) is increasing in Asia, and these conditions often coexist. We previously revealed a tendency of beta-blocker underuse among patients with HF with reduced ejection fraction (HFrEF) and COPD in Asian countries other than Japan. Here, we evaluated the impact of cardio-selective beta-blocker use on the long-term outcomes of patients with HF and COPD. METHODS AND RESULTS Among the 5232 patients with HFrEF (left ventricular ejection fraction of <40%) prospectively enrolled from 11 Asian regions in the ASIAN-HF registry, 412 (7.9%) had a history of COPD. We compared the clinical characteristics and long-term outcomes of the patients with HF and COPD according to the use and type of beta-blockers used: cardio-selective beta-blockers (n = 149) vs. non-cardio-selective beta-blockers (n = 124) vs. no beta-blockers (n = 139). The heart rate was higher, and the outcome was poorer in the no beta-blocker group than in the beta-blocker groups. The 2 year all-cause mortality was significantly lower in the non-cardio-selective beta-blocker group than in the no beta-blocker group. Further, the cardiovascular mortality significantly decreased in the non-cardio-selective beta-blocker group before (hazard ratio: 0.36; 95% confidence interval: 0.18-0.73; P = 0.004) and after adjustments (hazard ratio: 0.37; 95% confidence interval: 0.19-0.73; P = 0.005), but not in the cardio-selective beta-blocker group. CONCLUSIONS Beta-blockers reduced the all-cause mortality of patients with HFrEF and COPD after adjusting for age and heart rate, although the possibility of selection bias could not be completely excluded due to multinational prospective registry.
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Affiliation(s)
- Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-0022, Japan
| | | | | | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-0022, Japan
| | - Takashi Noda
- Division of Cardiology, Department of Internal Medicine, National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Kengo Kusano
- Division of Cardiology, Department of Internal Medicine, National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shinji Hisatake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Omori Hospital, Tokyo, Japan
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Omori Hospital, Tokyo, Japan
| | - Ryobun Yasuoka
- Division of Cardiology, Department of Internal Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Takashi Kurita
- Division of Cardiology, Department of Internal Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-0022, Japan
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Beta-blocker therapy in patients with COPD: a systematic literature review and meta-analysis with multiple treatment comparison. Respir Res 2021; 22:64. [PMID: 33622362 PMCID: PMC7903749 DOI: 10.1186/s12931-021-01661-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Beta-blockers are associated with reduced mortality in patients with cardiovascular disease but are often under prescribed in those with concomitant COPD, due to concerns regarding respiratory side-effects. We investigated the effects of beta-blockers on outcomes in patients with COPD and explored within-class differences between different agents. METHODS We searched the Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medline for observational studies and randomized controlled trials (RCTs) investigating the effects of beta-blocker exposure versus no exposure or placebo, in patients with COPD, with and without cardiovascular indications. A meta-analysis was performed to assess the association of beta-blocker therapy with acute exacerbations of COPD (AECOPD), and a network meta-analysis was conducted to investigate the effects of individual beta-blockers on FEV1. Mortality, all-cause hospitalization, and quality of life outcomes were narratively synthesized. RESULTS We included 23 observational studies and 14 RCTs. In pooled observational data, beta-blocker therapy was associated with an overall reduced risk of AECOPD versus no therapy (HR 0.77, 95%CI 0.70 to 0.85). Among individual beta-blockers, only propranolol was associated with a relative reduction in FEV1 versus placebo, among 199 patients evaluated in RCTs. Narrative syntheses on mortality, all-cause hospitalization and quality of life outcomes indicated a high degree of heterogeneity in study design and patient characteristics but suggested no detrimental effects of beta-blocker therapy on these outcomes. CONCLUSION The class effect of beta-blockers remains generally positive in patients with COPD. Reduced rates of AECOPD, mortality, and improved quality of life were identified in observational studies, while propranolol was the only agent associated with a deterioration of lung function in RCTs.
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de-Miguel-Diez J, Jiménez-García R, Hernandez-Barrera V, Ji Z, de Miguel-Yanes JM, López-Herranz M, López-de-Andrés A. Sex Differences in the Effects of COPD on Incidence and Outcomes of Patients Hospitalized with ST and Non-ST Elevation Myocardial Infarction: A Population-Based Matched-Pair Analysis in Spain (2016-2018). J Clin Med 2021; 10:jcm10040652. [PMID: 33567687 PMCID: PMC7914459 DOI: 10.3390/jcm10040652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
We aimed to compare the incidence, clinical characteristics, and outcomes of patients admitted with myocardial infarction (MI), whether ST elevation MI (STEMI) or non-ST elevation MI (NSTEMI), according to the presence of chronic obstructive pulmonary disease (COPD), and to identify variables associated with in-hospital mortality (IHM). We selected all patients with MI (aged ≥40 years) included in the Spanish National Hospital Discharge Database (2016–2018). We matched each patient suffering COPD with a non-COPD patient with identical age, sex, type of MI, and year of hospitalization. We identified 109,759 men and 44,589 women with MI. The MI incidence was higher in COPD patients (incident rate ratio (IRR) 1.32; 95% confidence interval (CI) 1.29–1.35). Men with COPD had higher incidence of STEMI and NSTEMI than women with COPD. After matching, COPD men had a higher IHM than non-COPD men, but no differences were found among women. The probability of dying was higher among COPD men with STEMI in comparison with NSTEMI (odds ratio (OR) 2.33; 95% CI 1.96–2.77), with this risk being higher among COPD women (OR 2.63; 95% CI 1.75–3.95). Suffering COPD increased the IHM after an MI in men (OR 1.14; 95% CI 1.03–1.27), but no differences were found in women. COPD women had a higher IHM than men (OR 1.19; 95% CI 1.01–1.39). We conclude that MI incidence was higher in COPD patients. IHM was higher in COPD men than in those without COPD, but no differences were found among women. Among COPD patients, STEMI was more lethal than NSTEMI. Suffering COPD increased the IHM after MI among men. Women with COPD had a significantly higher probability of dying in the hospital than COPD men.
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Affiliation(s)
- Javier de-Miguel-Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.d.-M.-D.); (Z.J.)
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Correspondence: ; Tel.: +34-91-394-1521
| | - Valentín Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain;
| | - Zichen Ji
- Pneumology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.d.-M.-D.); (Z.J.)
| | | | - Marta López-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Ana López-de-Andrés
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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11
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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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12
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Baou K, Katsi V, Makris T, Tousoulis D. Beta Blockers and Chronic Obstructive Pulmonary Disease (COPD): Sum of Evidence. Curr Hypertens Rev 2020; 17:196-206. [PMID: 33302840 DOI: 10.2174/1573402116999201209203250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022]
Abstract
Approximately, half a century has passed since the discovery of beta blockers. Then, their prime therapeutic purpose was to treat angina and cardiac arrhythmias, nowadays, beta blockers' usage and effectiveness is extended to treat other cardiovascular diseases, such as hypertension, congestive heart failure, and coronary artery disease. Safety concerns were raised about beta blockers and their use for chronic obstructive pulmonary disease (COPD) patients with concurrent cardiovascular disease. After a thorough research of the literature, this review summarizes the evidence proving that beta blockers not only might be well tolerated in COPD patients, but they might also have a beneficial effect in this group of patients.
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Affiliation(s)
- Katerina Baou
- First Department of Pulmonary Medicine, Sismanoglio Hospital, Sismanogliou 1, Marousi,. Greece
| | - Vasiliki Katsi
- First Department of Cardiology, Hippokration Hospital, University of Athens, Vasilissis Sofias 114, Athens,. Greece
| | - Thomas Makris
- Department of Cardiology, Helena Venizelou Hospital, Helenas Venizelou 2 Square, Ampelokipi,. Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, University of Athens, Vasilissis Sofias 114, Athens,. Greece
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13
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Andreas S, Bothner U, de la Hoz A, Kloer I, Trampisch M, Alter P. A Post Hoc Holter ECG Analysis of Olodaterol and Formoterol in Moderate-to-Very-Severe COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:1955-1965. [PMID: 32848381 PMCID: PMC7428408 DOI: 10.2147/copd.s246353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) are at risk of developing cardiac arrhythmias and elevated heart rate. A theoretical mechanistic association based on the interaction of long-acting β2-agonists (LABAs) with adrenoreceptors in the heart and vasculature is assumed as a potential class-related risk. Therefore, we performed a pooled analysis of Holter electrocardiogram (ECG) data from four 48-week, randomized, double-blind, placebo-controlled, parallel-group, Phase III clinical trials evaluating olodaterol (5 μg or 10 μg) or formoterol (12 µg) versus placebo. Methods We analyzed Holter ECG data from a representative subset of 775 patients with Global Initiative for Chronic Obstructive Lung Disease stage 2–4 COPD from four studies (1222.11–14) assessing olodaterol (5 μg and 10 μg) and formoterol (12 µg) versus placebo. Results No statistically significant (P>0.3) or clinically relevant differences in the shift from baseline of premature supraventricular or ventricular beats were observed among the active treatment and the placebo groups. Minor and transient differences were observed in the adjusted mean heart rate from baseline during treatment in all groups. There was a numerically small but statistically significant increase for formoterol at Week 24, olodaterol 5 μg at Weeks 12 and 40, and olodaterol 10 μg at Week 40 (all less than 3.0 beats per minute). Mean heart rates returned to a statistically non-significant change at Week 48 for all treatment groups. No increase in major adverse cardiovascular events was observed. Conclusion Treatment with olodaterol or formoterol is not associated with arrhythmias or a persistent increase in heart rate as assessed by Holter ECG in patients with COPD. Trial Registration ClinicalTrials.gov identifiers: NCT00782210 (1222.11); NCT00782509 (1222.12); NCT00793624 (1222.13); NCT00796653 (1222.14).
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Affiliation(s)
- Stefan Andreas
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,LungClinic Immenhausen, Immenhausen, Germany, Member of the German Center for Lung Research (DZL)
| | - Ulrich Bothner
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Isabel Kloer
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany, Member of the German Center for Lung Research (DZL)
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14
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Goedemans L, Bax JJ, Delgado V. COPD and acute myocardial infarction. Eur Respir Rev 2020; 29:29/156/190139. [PMID: 32581139 DOI: 10.1183/16000617.0139-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022] Open
Abstract
COPD is strongly associated with cardiovascular disease, in particular acute myocardial infarction (AMI). Besides shared risk factors, COPD-related factors, such as systemic inflammation and hypoxia, underlie the pathophysiological interaction between COPD and AMI. The prevalence of COPD amongst AMI populations ranges from 7% to 30%, which is possibly even an underestimation due to underdiagnoses of COPD in general. Following the acute event, patients with COPD have an increased risk of mortality, heart failure and arrhythmias during follow-up. Adequate risk stratification can be performed using various imaging techniques, evaluating cardiac size and function after AMI. Conventional imaging techniques such as echocardiography and cardiac magnetic resonance imaging have already indicated impaired cardiac function in patients with COPD without known cardiovascular disease. Advanced imaging techniques such as speckle-tracking echocardiography and T1 mapping could provide more insight into cardiac structure and function after AMI and have proven to be of prognostic value. Future research is required to better understand the impact of AMI on patients with COPD in order to provide effective secondary prevention. The present article summarises the current knowledge on the pathophysiologic factors involved in the interaction between COPD and AMI, the prevalence and outcomes of AMI in patients with COPD and the role of imaging in the acute phase and risk stratification after AMI in patients with COPD.
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Affiliation(s)
- Laurien Goedemans
- Dept of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J Bax
- Dept of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Dept of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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15
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Lunney M, Ruospo M, Natale P, Quinn RR, Ronksley PE, Konstantinidis I, Palmer SC, Tonelli M, Strippoli GFM, Ravani P. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev 2020; 2:CD012466. [PMID: 32103487 PMCID: PMC7044419 DOI: 10.1002/14651858.cd012466.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately half of people with heart failure have chronic kidney disease (CKD). Pharmacological interventions for heart failure in people with CKD have the potential to reduce death (any cause) or hospitalisations for decompensated heart failure. However, these interventions are of uncertain benefit and may increase the risk of harm, such as hypotension and electrolyte abnormalities, in those with CKD. OBJECTIVES This review aims to look at the benefits and harms of pharmacological interventions for HF (i.e., antihypertensive agents, inotropes, and agents that may improve the heart performance indirectly) in people with HF and CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies through 12 September 2019 in consultation with an Information Specialist and using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials of any pharmacological intervention for acute or chronic heart failure, among people of any age with chronic kidney disease of at least three months duration. DATA COLLECTION AND ANALYSIS Two authors independently screened the records to identify eligible studies and extracted data on the following dichotomous outcomes: death, hospitalisations, worsening heart failure, worsening kidney function, hyperkalaemia, and hypotension. We used random effects meta-analysis to estimate treatment effects, which we expressed as a risk ratio (RR) with 95% confidence intervals (CI). We assessed the risk of bias using the Cochrane tool. We applied the GRADE methodology to rate the certainty of evidence. MAIN RESULTS One hundred and twelve studies met our selection criteria: 15 were studies of adults with CKD; 16 studies were conducted in the general population but provided subgroup data for people with CKD; and 81 studies included individuals with CKD, however, data for this subgroup were not provided. The risk of bias in all 112 studies was frequently high or unclear. Of the 31 studies (23,762 participants) with data on CKD patients, follow-up ranged from three months to five years, and study size ranged from 16 to 2916 participants. In total, 26 studies (19,612 participants) reported disaggregated and extractable data on at least one outcome of interest for our review and were included in our meta-analyses. In acute heart failure, the effects of adenosine A1-receptor antagonists, dopamine, nesiritide, or serelaxin on death, hospitalisations, worsening heart failure or kidney function, hyperkalaemia, hypotension or quality of life were uncertain due to sparse data or were not reported. In chronic heart failure, the effects of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (4 studies, 5003 participants: RR 0.85, 95% CI 0.70 to 1.02; I2 = 78%; low certainty evidence), aldosterone antagonists (2 studies, 34 participants: RR 0.61 95% CI 0.06 to 6.59; very low certainty evidence), and vasopressin receptor antagonists (RR 1.26, 95% CI 0.55 to 2.89; 2 studies, 1840 participants; low certainty evidence) on death (any cause) were uncertain. Treatment with beta-blockers may reduce the risk of death (any cause) (4 studies, 3136 participants: RR 0.69, 95% CI 0.60 to 0.79; I2 = 0%; moderate certainty evidence). Treatment with ACEi or ARB (2 studies, 1368 participants: RR 0.90, 95% CI 0.43 to 1.90; I2 = 97%; very low certainty evidence) had uncertain effects on hospitalisation for heart failure, as treatment estimates were consistent with either benefit or harm. Treatment with beta-blockers may decrease hospitalisation for heart failure (3 studies, 2287 participants: RR 0.67, 95% CI 0.43 to 1.05; I2 = 87%; low certainty evidence). Aldosterone antagonists may increase the risk of hyperkalaemia compared to placebo or no treatment (3 studies, 826 participants: RR 2.91, 95% CI 2.03 to 4.17; I2 = 0%; low certainty evidence). Renin inhibitors had uncertain risks of hyperkalaemia (2 studies, 142 participants: RR 0.86, 95% CI 0.49 to 1.49; I2 = 0%; very low certainty). We were unable to estimate whether treatment with sinus node inhibitors affects the risk of hyperkalaemia, as there were few studies and meta-analysis was not possible. Hyperkalaemia was not reported for the CKD subgroup in studies investigating other therapies. The effects of ACEi or ARB, or aldosterone antagonists on worsening heart failure or kidney function, hypotension, or quality of life were uncertain due to sparse data or were not reported. Effects of anti-arrhythmic agents, digoxin, phosphodiesterase inhibitors, renin inhibitors, sinus node inhibitors, vasodilators, and vasopressin receptor antagonists were very uncertain due to the paucity of studies. AUTHORS' CONCLUSIONS The effects of pharmacological interventions for heart failure in people with CKD are uncertain and there is insufficient evidence to inform clinical practice. Study data for treatment outcomes in patients with heart failure and CKD are sparse despite the potential impact of kidney impairment on the benefits and harms of treatment. Future research aimed at analysing existing data in general population HF studies to explore the effect in subgroups of patients with CKD, considering stage of disease, may yield valuable insights for the management of people with HF and CKD.
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Affiliation(s)
- Meaghan Lunney
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
| | - Marinella Ruospo
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | - Patrizia Natale
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | - Robert R Quinn
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
| | - Paul E Ronksley
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
| | - Ioannis Konstantinidis
- University of Pittsburgh Medical CenterDepartment of Medicine3459 Fifth AvenuePittsburghPAUSA15213
| | - Suetonia C Palmer
- Christchurch Hospital, University of OtagoDepartment of Medicine, NephrologistChristchurchNew Zealand
| | - Marcello Tonelli
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
| | - Giovanni FM Strippoli
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - Pietro Ravani
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
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16
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Schmidt M, Horváth-Puhó E, Ording AG, Bøtker HE, Lash TL, Sørensen HT. The interaction effect of cardiac and non-cardiac comorbidity on myocardial infarction mortality: A nationwide cohort study. Int J Cardiol 2020; 308:1-8. [PMID: 32057473 DOI: 10.1016/j.ijcard.2020.01.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/09/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Whether the prognostic impact of comorbidity on myocardial infarction (MI) mortality is due to comorbidity alone or/and its interaction effect is unknown. METHODS We used Danish medical registries to conduct a nationwide cohort study of all first-time MIs during 1995-2016 (n = 179,515) and a comparison cohort matched on age, sex, and individual comorbidities (n = 880,347). We calculated age-standardized 5-year all-cause mortality rates. Interaction was examined on an additive scale by calculating interaction contrasts (difference in rate differences). RESULTS Among individuals without comorbidity, the 30-day mortality rate per 1000 person-years was 1851 (95% CI: 1818-1884) for MI patients and 22 (21-24) for comparison cohort members (rate difference = 1829). For individuals with low comorbidity, corresponding baseline mortality rates were 2498 (2436-2560) in the MI and 54 (50-57) in the comparison cohort (rate difference = 2444). The interaction contrast (616) indicated that the interaction accounted for 25% (616/2498) of the total 30-day mortality rate in MI patients with low comorbidity. This percentage increased further for moderate (35%) and severe (45%) comorbidity levels. Absolute and relative interaction effects were largest within the first 30 days and younger individuals. Dose-response patterns were also observed during 31-365 days and 1-5 years of follow-up (p-values for trends<0.002). The interaction differed substantially between individual types of cardiac and non-cardiac comorbidities. CONCLUSION Cardiac and non-cardiac comorbidities interact with MI to increase short- and long-term mortality beyond that explained by their additive effects. The interaction had a dose-response relation with comorbidity burden and a magnitude of clinical importance.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
| | | | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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17
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Alter P, Mayerhofer BA, Kahnert K, Watz H, Waschki B, Andreas S, Biertz F, Bals R, Vogelmeier CF, Jörres RA. Prevalence of cardiac comorbidities, and their underdetection and contribution to exertional symptoms in COPD: results from the COSYCONET cohort. Int J Chron Obstruct Pulmon Dis 2019; 14:2163-2172. [PMID: 31571852 PMCID: PMC6759215 DOI: 10.2147/copd.s209343] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/10/2019] [Indexed: 12/21/2022] Open
Abstract
Background A substantial prevalence of cardiovascular disease is known for COPD, but detection of its presence, relationship to functional findings and contribution to symptoms remains challenging. The present analysis focusses on the cardiovascular contribution to COPD symptoms and their relationship to the patients’ diagnostic status, medication and echocardiographic findings. Methods Patients from the COPD cohort COSYCONET with data on lung function, including FEV1, residual volume/total lung capacity (RV/TLC) ratio, diffusing capacity TLCO, and echocardiographic data on left ventricular ejection fraction (LVEF) and end-diastolic diameter (LVEDD), medical history, medication, modified British Medical Research Council dyspnea scale (mMRC) and Saint Georges Respiratory Questionnaire (SGRQ) were analyzed. Results A total of 1591 patients (GOLD 0–4: n=230/126/614/498/123) fulfilled the inclusion criteria. Ischemic heart disease, myocardial infarction or heart failure were reported in 289 patients (18.2%); 860 patients (54%) received at least one cardiovascular medication, with more than one in many patients. LVEF<50% or LVEDD>56 mm was found in 204 patients (12.8%), of whom 74 (36.3%) had neither a cardiovascular history nor medication. Among 948 patients (59.6%) without isolated hypertension, there were 21/55 (38.2%) patients with LVEF<50% and 47/88 (53.4%) with LVEDD>56 mm, who lacked both a cardiac diagnosis and medication. LVEDD and LVEF were linked to medical history; LVEDD was dependent on RV/TLC and LVEF on FEV1. Exertional COPD symptoms were best described by mMRC and the SGRQ activity score. Beyond lung function, an independent link from LVEDD on symptoms was revealed. Conclusion A remarkable proportion of patients with suspicious echocardiographic findings were undiagnosed and untreated, implying an increased risk for an unfavorable prognosis. Cardiac size and function were dependent on lung function and only partially linked to cardiovascular history. Although the contribution of LV size to COPD symptoms was small compared to lung function, it was detectable irrespective of all other influencing factors. However, only the mMRC and SGRQ activity component were found to be suitable for this purpose.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Barbara A Mayerhofer
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the Center for Lung Research (DZL), Munich, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Benjamin Waschki
- Department of Pneumology, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany.,Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Stefan Andreas
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany.,Lung Clinic, Immenhausen, Germany
| | - Frank Biertz
- Institute for Biostatistics, Center for Biometry, Medical Informatics and Medical Technology, Hannover Medical School, Hannover, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the Center for Lung Research (DZL), Munich, Germany
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18
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Abstract
The use of beta-blockers in patients with chronic obstructive pulmonary disease (COPD) has received much attention. Several observational studies reported important reductions in mortality and exacerbations with these drugs, but the extent of bias in these studies is unclear. Nevertheless, the large ongoing randomized trial (βLOCK-COPD) was initiated specifically to evaluate these effects. We searched the literature to identify all observational studies investigating the effectiveness of beta-blockers in COPD patients on major outcomes, including death and COPD exacerbation. We identified 18 observational studies, with 10 studies affected by confounding bias and six by immortal time bias, while two addressed these biases. Reductions in all-cause mortality with beta-blocker use were observed among the studies with confounding bias (pooled rate ratio 0.72; 95% CI 0.59-0.88) and those with immortal time bias (pooled rate ratio 0.64; 95% CI 0.53-0.77). A large five-database study that addressed these two biases reported hazard ratios of 0.90 (95% CI: 0.78-1.02) for death and 0.54 (95% CI: 0.47-0.61) for COPD hospitalization. However, this latter estimate was the same as for the first 30 days after treatment initiation, thus indicating that important residual confounding cannot be ruled out. Observational studies, important to provide evidence from real-world data on medication effects, are unsupportive for beta-blockers in COPD. Even if immortal time bias is properly avoided, confounding bias cannot be fully controlled due to their relative contraindication in COPD. In the case of beta-blockers, randomized trials such as βLOCK-COPD are necessary to eliminate the uncertainty from residual confounding bias.
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Affiliation(s)
- Samy Suissa
- a Center for Clinical Epidemiology, Lady Davis Institute - Jewish General Hospital , Montreal , Canada.,b Departments of Epidemiology and Biostatistics and of Medicine , McGill University , Montreal , Canada
| | - Pierre Ernst
- b Departments of Epidemiology and Biostatistics and of Medicine , McGill University , Montreal , Canada
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Wang H, Zhao T, Wei X, Lu H, Lin X. The prevalence of 30-day readmission after acute myocardial infarction: A systematic review and meta-analysis. Clin Cardiol 2019; 42:889-898. [PMID: 31407368 PMCID: PMC6788479 DOI: 10.1002/clc.23238] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 11/10/2022] Open
Abstract
Objective The 30‐day readmission is associated with increased medical costs, which has become an important quality metric in several medical institutions. This current study is aimed at clarifying the prevalence, the underlying risk factors, and reasons of the 30‐day readmission after acute myocardial infarction (AMI). Methods PubMed, Cochrane Library, and EMBASE were systematically searched to identify eligible studies. Random‐effect models were employed to perform pooled analyses. Means and 95% confidence intervals (CIs) were used to estimate prevalence and reasons for 30‐day readmission. We also used Odds ratios (ORs) to explore the potential significant predictors of risk factors of 30‐day readmission after AMI. Potential publication bias was assessed using funnel plot and Begg'test. Results A total of 14 relevant studies were included in this systematic review and meta‐analysis. The pooled 30‐day readmission rate of AMI was 12% (95% CI 0.11‐0.14). Acute coronary syndrome (ACS), angina and acute ischemic heart disease, and heart failure (HF) were the principal cardiovascular reasons of 30‐day readmission. Meanwhile, non‐specific chest pain was regarded as the significant cause among non‐cardiovascular reasons. The common co‐morbidities kidney disease, HF and diabetes mellitus were significant risk factors for 30‐day readmission. No significant publication bias was found by funnel plot and statistical tests. Conclusions The 30‐day readmission rate of post‐AMI ranged from 11% to 14% and can be mainly attributed to cardiovascular and non‐cardiovascular events. The common co‐morbidities, such as kidney disease, HF, and diabetes mellitus were significant risk factors for 30‐day readmission.
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Affiliation(s)
- Huijie Wang
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
| | - Ting Zhao
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
| | - Xiaoliang Wei
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
| | - Huifang Lu
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
| | - Xiufang Lin
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiPR China
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20
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Gazizyanova VM, Bulashova OV, Hazova EV, Hasanov NR, Oslopov VN. [Clinical features and prognosis in heart failure patients with chronic obstructive pulmonary diseases]. ACTA ACUST UNITED AC 2019; 59:51-60. [PMID: 31340749 DOI: 10.18087/cardio.2674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multimorbidity is a specific characteristic of the modern patient with chronic heart failure (CHF) which significantly changes clinical course, prognosis of the syndrome, leads to socio‑economic losses and makes significant adjustments to treatment tactics. The goal is to study the clinical features and prognosis of patients with CHF in combination with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS We studied 183 HF patients, including with stable CHF, including 105 with CHF combined with COPD. The clinical phenotype was assessed by its belonging to the functional class and the severity of COPD. A 6‑minute walk test (6‑MWT), spirometry, echocardioscopy, testing on a scale assessing the clinical condition, quality of life were studied. The end points during the year were: all‑cause mortality and cardiovascular mortality, myocardial infarction, stroke, pulmonary embolism, and hospitalization rates due to acute decompensation of CHF. RESULTS The clinical phenotype of CHF combined with COPD was characterized by a high frequency of smoking, low quality of life and exercise tolerance. Respiratory dysfunction in CHF in combination with COPD was characterized by mixed disorders (68.4%), in CHF without lung disease, restrictive (25.6%). Cardiovascular mortality in comorbid pathology was 4.0%, in CHF without COPD - 4.6%; myocardial infarction was observed 1.7 times more often with lung disease than in patients with CHF only (16.8% and 10.8%); stroke was observed exclusively in comorbid pathology (8.9%). The combined endpoint (all cardiovascular events) with CHF in combination with COPD was achieved 2.3 times more often in comparison with patients with COPD only (29.7% and 15.4%). Hospitalization due to acute decompensation of CHF occurred 2 times more often with CHF in combination with COPD than without it (32.7% and 15.4%) with a tendency to increase as the left ventricular ejection fraction decreased. CONCLUSION The results of the study demonstrate that COPD contributes to the formation of the clinical phenotype of CHF from the standpoint of the mutual influence of the characteristics of the cardiovascular and respiratory systems, and also aggravates the prognosis that requires an integrated approach to the differential diagnosis and individualization of pharmacotherapy.
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21
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Franssen FME, Alter P, Bar N, Benedikter BJ, Iurato S, Maier D, Maxheim M, Roessler FK, Spruit MA, Vogelmeier CF, Wouters EFM, Schmeck B. Personalized medicine for patients with COPD: where are we? Int J Chron Obstruct Pulmon Dis 2019; 14:1465-1484. [PMID: 31371934 PMCID: PMC6636434 DOI: 10.2147/copd.s175706] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
Chronic airflow limitation is the common denominator of patients with chronic obstructive pulmonary disease (COPD). However, it is not possible to predict morbidity and mortality of individual patients based on the degree of lung function impairment, nor does the degree of airflow limitation allow guidance regarding therapies. Over the last decades, understanding of the factors contributing to the heterogeneity of disease trajectories, clinical presentation, and response to existing therapies has greatly advanced. Indeed, diagnostic assessment and treatment algorithms for COPD have become more personalized. In addition to the pulmonary abnormalities and inhaler therapies, extra-pulmonary features and comorbidities have been studied and are considered essential components of comprehensive disease management, including lifestyle interventions. Despite these advances, predicting and/or modifying the course of the disease remains currently impossible, and selection of patients with a beneficial response to specific interventions is unsatisfactory. Consequently, non-response to pharmacologic and non-pharmacologic treatments is common, and many patients have refractory symptoms. Thus, there is an ongoing urgency for a more targeted and holistic management of the disease, incorporating the basic principles of P4 medicine (predictive, preventive, personalized, and participatory). This review describes the current status and unmet needs regarding personalized medicine for patients with COPD. Also, it proposes a systems medicine approach, integrating genetic, environmental, (micro)biological, and clinical factors in experimental and computational models in order to decipher the multilevel complexity of COPD. Ultimately, the acquired insights will enable the development of clinical decision support systems and advance personalized medicine for patients with COPD.
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Affiliation(s)
- Frits ME Franssen
- Department of Research and Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Nadav Bar
- Department of Chemical Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Birke J Benedikter
- Institute for Lung Research, Universities of Giessen and Marburg Lung Centre, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
- Department of Medical Microbiology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | | | | | - Michael Maxheim
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Fabienne K Roessler
- Department of Chemical Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Martijn A Spruit
- Department of Research and Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Emiel FM Wouters
- Department of Research and Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Bernd Schmeck
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
- Institute for Lung Research, Universities of Giessen and Marburg Lung Centre, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
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22
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Rusnak J, Behnes M, Schupp T, Reiser L, Bollow A, Taton G, Reichelt T, Ellguth D, Engelke N, Hoppner J, Weidner K, El-Battrawy I, Mashayekhi K, Weiß C, Borggrefe M, Akin I. COPD increases cardiac mortality in patients presenting with ventricular tachyarrhythmias and aborted cardiac arrest. Respir Med 2018; 145:153-160. [DOI: 10.1016/j.rmed.2018.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 01/24/2023]
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23
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Alter P, Jörres RA, Watz H, Welte T, Gläser S, Schulz H, Bals R, Karch A, Wouters EFM, Vestbo J, Young D, Vogelmeier CF. Left ventricular volume and wall stress are linked to lung function impairment in COPD. Int J Cardiol 2018; 261:172-178. [PMID: 29657040 DOI: 10.1016/j.ijcard.2018.02.074] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/13/2018] [Accepted: 02/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiovascular comorbidities are common in chronic obstructive pulmonary disease (COPD). We examined the association between airflow limitation, hyperinflation and the left ventricle (LV). METHODS Patients from the COPD cohort COSYCONET underwent evaluations including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), effective airway resistance (Reff), intrathoracic gas volume (ITGV), and echocardiographic LV end-diastolic volume (LVEDV), stroke volume (LVSV), end-systolic volume (LVESV), and end-diastolic and end-systolic LV wall stress. Data from Visit 1 (baseline) and Visit 3 (18 months later) were used. In addition to comparisons of both visits, multivariate regression analysis was conducted, followed by structural equation modelling (SEM) with latent variables "Lung" and "Left heart". RESULTS A total of 641 participants were included in this analysis. From Visit 1 to Visit 3, there were significant declines in FEV1 and FEV1/FVC, and increases in Reff, ITGV and LV end-diastolic wall stress, and a borderline significant decrease in LV mass. There were significant correlations of: FEV1% predicted with LVEDV and LVSV; Reff with LVSV; and ITGV with LV mass and LV end-diastolic wall stress. The SEM fitted the data of both visits well (comparative fit index: 0.978, 0.962), with strong correlation between "Lung" and "Left heart". CONCLUSIONS We demonstrated a relationship between lung function impairment and LV wall stress in patients with COPD. This supports the hypothesis that LV impairment in COPD could be initiated or promoted, at least partly, by mechanical factors exerted by the lung disorder.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany.
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University, Comprehensive Pneumology Centre Munich (CPC-M), Member of the German Centre for Lung Research (DZL), Munich, Germany.
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Grosshansdorf, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Sven Gläser
- Department for Pneumology, University of Greifswald, Greifswald, Germany
| | - Holger Schulz
- Helmholtz Centre Munich, Institute of Epidemiology, German Research Centre for Environmental Health, Comprehensive Pneumology Centre Munich (CPC-M), Member of the German Centre for Lung Research (DZL), Munich, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Germany
| | - Annika Karch
- Institute for Biostatistics, Centre for Biometry, Medical Informatics and Medical Technology, Hannover Medical School, Hannover, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - David Young
- Young Medical Communications and Consulting Limited, Horsham, UK
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany
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24
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González-Costello J, Comín-Colet J, Lupón J, Enjuanes C, de Antonio M, Fuentes L, Moliner-Borja P, Farré N, Zamora E, Manito N, Pujol R, Bayés-Genis A. Importance of iron deficiency in patients with chronic heart failure as a predictor of mortality and hospitalizations: insights from an observational cohort study. BMC Cardiovasc Disord 2018; 18:206. [PMID: 30382817 PMCID: PMC6211465 DOI: 10.1186/s12872-018-0942-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background Iron deficiency (ID) in patients with chronic heart failure (CHF) is considered an adverse prognostic factor. We aimed to evaluate if ID in patients with CHF is associated with increased mortality and hospitalizations. Methods We evaluated ID in patients with CHF at 3 university hospitals. ID was defined as absolute (ferritin < 100 μg/L) or functional (transferrin Saturation index < 20% and ferritin between 100 and 299 μg/L). We excluded patients who received treatment with intravenous Iron or Erythropoietin during follow-up. We evaluated if ID was a predictor of death or hospitalization due to heart failure or any cause using univariate and multivariate cox regression analysis. Results We included 1684 patients, 65% males, 38% diabetics, median age of 72 years, 37% in functional class III-IV and 30% of patients with a left ventricular ejection fraction > 45%. Patients were well treated, with 87% and 88% of patients receiving renin-angiotensin inhibitors and beta-blockers, respectively. Median transferrin saturation index was 20%, median ferritin 155 ng/mL and median haemoglobin 13 g/dL. ID was present in 53% of patients; in 35% it was absolute and in 18% functional. Median follow-up was 20 months. ID was a predictor of death, hospitalization due to heart failure or to any cause in univariate analysis but not after multivariate analysis. No differences were found between absolute or functional ID regarding prognosis. Conclusion In a real life population of patients with CHF and a high prevalence of heart failure with preserved ejection fraction, ID did not predict mortality or hospitalizations after adjustment for comorbidities, functional class and neurohormonal treatment.
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Affiliation(s)
- José González-Costello
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain.
| | - Josep Comín-Colet
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Josep Lupón
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Cristina Enjuanes
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta de Antonio
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Lara Fuentes
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Pedro Moliner-Borja
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Farré
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisabet Zamora
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Nicolás Manito
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Ramón Pujol
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés-Genis
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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25
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Tural Onur S, Emet S, Sokucu SN, Onur I. T wave peak-to-end interval in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2157-2162. [PMID: 30034231 PMCID: PMC6049052 DOI: 10.2147/copd.s132538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction The interval from the peak to the end of the electrocardiographic (ECG) T wave (Tp–Te) can estimate cardiovascular mortality and ventricular tachyarrhythmias. Objectives In this study, we aimed to define a new ECG parameter in patients with COPD. Methods This was a cross-sectional observational study that included COPD patients who were diagnosed previously and followed up in the outpatient clinic. All data of the patients’ demographic features, history, spirometry, and electrocardiographs were analyzed. Results We enrolled 134 patients with COPD and 40 healthy volunteers as controls in our study. Patients already known to be having COPD who were under follow-up for their COPD and diagnosed as having COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. Men comprised 82.8% of the COPD group and 73.2% of controls. The mean age in the COPD and control group was 60.2±9.4 and 58.2±6.7 years, respectively. There was no significant difference between the groups for age or sex (p=0.207, p=0.267, respectively). There were 46 (34.3%) patients in group A, 23 (17.2%) patients in group B, 26 (19.4%) patients in group C, and 46 (29.1%) patients in group D as COPD group. There was a significant increase in Tp–Te results in all precordial leads in the COPD group compared with the control group (p<0.05). Precordial V4 lead has the most extensive area under the curve (0.831; sensitivity 76.5%, specificity 89.6%). Conclusion We present strong evidence that Tp–Te intervals were increased in patients with COPD, which suggests that there may be an association between COPD and ventricular arrhythmias and cardiac morbidity.
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Affiliation(s)
- Seda Tural Onur
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease, Zeytinburnu, Istanbul, Turkey,
| | - Samim Emet
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Sinem Nedime Sokucu
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease, Zeytinburnu, Istanbul, Turkey,
| | - Imran Onur
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
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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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27
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Hall M, Dondo TB, Yan AT, Mamas MA, Timmis AD, Deanfield JE, Jernberg T, Hemingway H, Fox KAA, Gale CP. Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort. PLoS Med 2018; 15:e1002501. [PMID: 29509764 PMCID: PMC5839532 DOI: 10.1371/journal.pmed.1002501] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/08/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is limited knowledge of the scale and impact of multimorbidity for patients who have had an acute myocardial infarction (AMI). Therefore, this study aimed to determine the extent to which multimorbidity is associated with long-term survival following AMI. METHODS AND FINDINGS This national observational study included 693,388 patients (median age 70.7 years, 452,896 [65.5%] male) from the Myocardial Ischaemia National Audit Project (England and Wales) who were admitted with AMI between 1 January 2003 and 30 June 2013. There were 412,809 (59.5%) patients with multimorbidity at the time of admission with AMI, i.e., having at least 1 of the following long-term health conditions: diabetes, chronic obstructive pulmonary disease or asthma, heart failure, renal failure, cerebrovascular disease, peripheral vascular disease, or hypertension. Those with heart failure, renal failure, or cerebrovascular disease had the worst outcomes (39.5 [95% CI 39.0-40.0], 38.2 [27.7-26.8], and 26.6 [25.2-26.4] deaths per 100 person-years, respectively). Latent class analysis revealed 3 multimorbidity phenotype clusters: (1) a high multimorbidity class, with concomitant heart failure, peripheral vascular disease, and hypertension, (2) a medium multimorbidity class, with peripheral vascular disease and hypertension, and (3) a low multimorbidity class. Patients in class 1 were less likely to receive pharmacological therapies compared with class 2 and 3 patients (including aspirin, 83.8% versus 87.3% and 87.2%, respectively; β-blockers, 74.0% versus 80.9% and 81.4%; and statins, 80.6% versus 85.9% and 85.2%). Flexible parametric survival modelling indicated that patients in class 1 and class 2 had a 2.4-fold (95% CI 2.3-2.5) and 1.5-fold (95% CI 1.4-1.5) increased risk of death and a loss in life expectancy of 2.89 and 1.52 years, respectively, compared with those in class 3 over the 8.4-year follow-up period. The study was limited to all-cause mortality due to the lack of available cause-specific mortality data. However, we isolated the disease-specific association with mortality by providing the loss in life expectancy following AMI according to multimorbidity phenotype cluster compared with the general age-, sex-, and year-matched population. CONCLUSIONS Multimorbidity among patients with AMI was common, and conferred an accumulative increased risk of death. Three multimorbidity phenotype clusters that were significantly associated with loss in life expectancy were identified and should be a concomitant treatment target to improve cardiovascular outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03037255.
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Affiliation(s)
- Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- * E-mail:
| | - Tatendashe B. Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Andrew T. Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Adam D. Timmis
- NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, London, United Kingdom
| | - John E. Deanfield
- National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Harry Hemingway
- Farr Institute of Health Informatics Research, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, London, United Kingdom
| | - Keith A. A. Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- York Teaching Hospital NHS Foundation Trust, York, United Kingdom
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28
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Alter P, Watz H, Kahnert K, Pfeifer M, Randerath WJ, Andreas S, Waschki B, Kleibrink BE, Welte T, Bals R, Schulz H, Biertz F, Young D, Vogelmeier CF, Jörres RA. Airway obstruction and lung hyperinflation in COPD are linked to an impaired left ventricular diastolic filling. Respir Med 2018; 137:14-22. [PMID: 29605197 DOI: 10.1016/j.rmed.2018.02.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 12/28/2022]
Abstract
AIMS Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases are thought to be linked through various factors. We aimed to assess the relationship between airway obstruction, lung hyperinflation and diastolic filling in COPD. METHODS The study population was a subset of the COPD cohort COSYCONET. Echocardiographic parameters included the left atrial diameter (LA), early (E) and late (A) transmitral flow, mitral annulus velocity (e'), E wave deceleration time (E[dt]), and isovolumic relaxation time (IVRT). We quantified the effect of various predictors including forced expiratory volume in 1 s (FEV1) and intrathoracic gas volume (ITGV) on the echocardiographic parameters by multiple linear regression and integrated the relationships into a path analysis model. RESULTS A total of 615 COPD patients were included (mean FEV1 52.6% predicted). In addition to influences of age, BMI and blood pressure, ITGV was positively related to e'-septal and negatively to LA, FEV1 positively to E(dt) (p < 0.05 each). The effect of predictors was most pronounced for LA, e'-septal and E(dt), and less for E/A, IVRT and E/e'. Path analysis was used to take into account the additional relationships between the echocardiographic parameters themselves, demonstrating that their associations with the predictors were maintained and robust. CONCLUSIONS Airway obstruction and lung hyperinflation were significantly associated with cardiac diastolic filling in patients with COPD, suggesting a decreased preload rather than an inherently impaired myocardial relaxation itself. This suggests that a reduction in obstruction and hyperinflation could help to improve cardiac filling.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany.
| | - Henrik Watz
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Grosshansdorf, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michael Pfeifer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Winfried J Randerath
- University of Cologne, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | - Stefan Andreas
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany; Lung Clinic, Immenhausen, Germany
| | - Benjamin Waschki
- Department of Pneumology, LungenClinic Grosshansdorf, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Grosshansdorf, Germany; Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Björn E Kleibrink
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg, Essen, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Germany
| | - Holger Schulz
- Helmholtz-Zentrum München, Institute of Epidemiology I, German Research Center for Environmental Health, Comprehensive Pneumology Centre Munich (CPC-M), Member of the German Centre for Lung Research (DZL), Munich, Germany
| | - Frank Biertz
- Institute for Biostatistics, Centre for Biometry, Medical Informatics and Medical Technology, Hannover Medical School, Hannover, Germany
| | - David Young
- Young Medical Communications and Consulting Limited, Horsham, UK
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University, Comprehensive Pneumology Centre Munich (CPC-M), Member of the German Centre for Lung Research (DZL), Munich, Germany.
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29
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Lim KP, Loughrey S, Musk M, Lavender M, Wrobel JP. Beta-blocker under-use in COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12:3041-3046. [PMID: 29089752 PMCID: PMC5655126 DOI: 10.2147/copd.s144333] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Cardiovascular (CVS) comorbidities are common in COPD and contribute significantly to morbidity and mortality, especially following acute exacerbations of COPD (AECOPD). Beta-blockers (BBs) are safe and effective in COPD patients, with demonstrated survival benefit following myocardial infarction. We sought to determine if BBs are under-prescribed in patients hospitalized with AECOPD. We also sought to determine inpatient rates of CVS and cerebrovascular complications, and their impact on patient outcomes. Methods Retrospective hospital data was collected over a 12-month period. The medical records of all patients >40 years of age coded with a diagnosis of AECOPD were analyzed. Prevalent use and incident initiation of BBs were assessed. Comorbidities including indications and contraindications for BB use were analyzed. Results Of the 366 eligible patients, 156 patients (42.6%) had at least one indication for BB use – of these patients, only 53 (34.0%) were on BB therapy and 61 (39.1%) were not on BB therapy but had no listed contraindication. Prevalent use of BBs at the time of admission in all 366 patients was 19.7%, compared with 45.6%, 39.6% and 45.9% use of anti-platelets, statins and angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers, respectively. CVS and cerebrovascular complications were common in this population (57 patients, 16%) and were associated with longer length of stay (p<0.01) and greater inpatient mortality (p=0.02). Conclusions BBs are under-prescribed in COPD patients despite clear indication(s) for their use. Further work is required to explore barriers to BB prescribing in COPD patients.
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Affiliation(s)
- Kuan Pin Lim
- Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia.,Respiratory Department, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Sarah Loughrey
- Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia
| | - Michael Musk
- Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia.,Respiratory Department, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Melanie Lavender
- Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia.,Respiratory Department, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Jeremy P Wrobel
- Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia.,Respiratory Department, Fiona Stanley Hospital, Murdoch, WA, Australia.,School of Medicine, University of Notre Dame, Fremantle, WA, Australia
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30
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Relation of Chronic Obstructive Pulmonary Disease to Cardiovascular Disease in the General Population. Am J Cardiol 2017; 120:1399-1404. [PMID: 28826898 DOI: 10.1016/j.amjcard.2017.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major health problem that contributes to substantial morbidity and mortality globally. This study investigated the relation between COPD and the risk of cardiovascular disease in the general population. We evaluated the cardiovascular effect of COPD using Korean National Health Insurance Service data from 2002 to 2013. We compared selected cardiovascular disease risk factors depending on pulmonary function using the Korean Health and Nutritional Examination Survey (KNHANES, n = 24,429) data. COPD was diagnosed in 11,771 patients (2.4%) in the National Health Insurance Service cohort. During the follow-up period (45.5 ± 14.9 months), subjects with COPD had lower cumulative survival rate for all-cause mortality, cardiovascular mortality, and sudden cardiac death (SCD, all p values <0.001). COPD was associated with an increased risk of all-cause mortality even after adjustment for potential confounding variables (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.33 to 1.55, p <0.001). However, COPD did not significantly increase the risk of cardiovascular mortality (HR 1.02, 95% CI 0.84 to 1.22, p = 0.876) and SCD (HR 1.07, 95% CI 0.79 to 1.44, p = 0.664) when adjusted for potential confounding variables. Analysis of the KNHANES cohort showed that systolic blood pressure, current smoking status, and Framingham risk score increased progressively with a decrease in pulmonary function (all p <0.001). In conclusion, COPD was associated with all-cause mortality, but not with cardiovascular mortality and SCD, whereas poor pulmonary function was associated with a heightened cardiovascular risk.
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31
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Liao KM, Lin TY, Huang YB, Kuo CC, Chen CY. The evaluation of β-adrenoceptor blocking agents in patients with COPD and congestive heart failure: a nationwide study. Int J Chron Obstruct Pulmon Dis 2017; 12:2573-2581. [PMID: 28894360 PMCID: PMC5584777 DOI: 10.2147/copd.s141694] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE β-Blockers are safe and improve survival in patients with both congestive heart failure (CHF) and COPD. However, the superiority of different types of β-blockers is still unclear among patients with CHF and COPD. The association between β-blockers and CHF exacerbation as well as COPD exacerbation remains unclear. The objective of this study was to compare the outcome of different β-blockers in patients with concurrent CHF and COPD. PATIENTS AND METHODS We used the National Health Insurance Research Database in Taiwan to conduct a retrospective cohort study. The inclusion criteria for CHF were patients who were >20 years old and were diagnosed with CHF between January 1, 2005 and December 31, 2012. COPD patients included those who had outpatient visit claims ≥2 times within 365 days or 1 claim for hospitalization with a COPD diagnosis. A time-dependent Cox proportional hazards regression model was applied to evaluate the effectiveness of β-blockers in the study population. RESULTS We identified 1,872 patients with concurrent CHF and COPD. Only high-dose bisoprolol significantly reduced the risk of death and slightly decreased the hospitalization rate due to CHF exacerbation (death: adjusted hazard ratio [aHR] =0.51, 95% confidence interval [CI] =0.29-0.89; hospitalization rate due to CHF exacerbation: aHR =0.48, 95% CI =0.23-1.00). No association was observed between β-blocker use and COPD exacerbation. CONCLUSION In patients with concurrent CHF and COPD, β-blockers reduced mortality, CHF exacerbation, and the need for hospitalization. Bisoprolol was found to reduce mortality and CHF exacerbation compared to carvedilol and metoprolol.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan
| | - Tien-Yu Lin
- School of Pharmacy, Kaohsiung Medical University
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China
| | - Yaw-Bin Huang
- School of Pharmacy, Kaohsiung Medical University
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China
| | | | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China
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32
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Mattila T, Vasankari T, Rissanen H, Knekt P, Puukka P, Heliövaara M. Airway obstruction and the risk of myocardial infarction and death from coronary heart disease: a national health examination survey with a 33-year follow-up period. Eur J Epidemiol 2017; 33:89-98. [DOI: 10.1007/s10654-017-0278-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/21/2017] [Indexed: 01/13/2023]
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33
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Riccio C, Gulizia MM, Colivicchi F, Di Lenarda A, Musumeci G, Faggiano PM, Abrignani MG, Rossini R, Fattirolli F, Valente S, Mureddu GF, Temporelli PL, Olivari Z, Amico AF, Casolo G, Fresco C, Menozzi A, Nardi F. ANMCO/GICR-IACPR/SICI-GISE Consensus Document: the clinical management of chronic ischaemic cardiomyopathy. Eur Heart J Suppl 2017; 19:D163-D189. [PMID: 28533729 PMCID: PMC5421493 DOI: 10.1093/eurheartj/sux021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Stable coronary artery disease (CAD) is a clinical entity of great epidemiological importance. It is becoming increasingly common due to the longer life expectancy, being strictly related to age and to advances in diagnostic techniques and pharmacological and non-pharmacological interventions. Stable CAD encompasses a variety of clinical and anatomic presentations, making the identification of its clinical and anatomical features challenging. Therapeutic interventions should be defined on an individual basis according to the patient's risk profile. To this aim, management flow charts have been reviewed based on sustainability and appropriateness derived from recent evidence. Special emphasis has been placed on non-pharmacological interventions, stressing the importance of lifestyle changes, including smoking cessation, regular physical activity, and diet. Adherence to therapy as an emerging risk factor is also discussed.
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Affiliation(s)
- Carmine Riccio
- Cardiovascular Science Department, A.O. Sant’Anna e San Sebastiano, Via Palasciano, 1 81100 Caserta, Italy
| | - Michele Massimo Gulizia
- Department of Cardiology, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Furio Colivicchi
- CCU Unit, Department of Cardiology, Presidio Ospedaliero San Filippo Neri, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | | | | | | | - Roberta Rossini
- Cardiology Department, A.O. Santa Croce e Carle, Cuneo, Italy
| | | | - Serafina Valente
- Intensive Integrated Cardiology Department, AOU Careggi, Florence, Italy
| | - Gian Francesco Mureddu
- Cardiology and Cardiac Rehabilitation Department, A.O. San Giovanni-Addolorata, Rome, Italy
| | | | - Zoran Olivari
- Department of Cardiology, Ospedale Ca’ Foncello, Treviso, Italy
| | | | - Giancarlo Casolo
- Cardiology Unit, Nuovo Ospedale Versilia, Lido di Camaiore, Lucca, Italy
| | - Claudio Fresco
- Cardiology Unit, A.O.U. Santa Maria della Misericordia, Udine, Italy
| | - Alberto Menozzi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
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Su TH, Chang SH, Chen PC, Chan YL. Temporal Trends in Treatment and Outcomes of Acute Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Observational Study. J Am Heart Assoc 2017; 6:e004525. [PMID: 28298371 PMCID: PMC5524002 DOI: 10.1161/jaha.116.004525] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute myocardial infarction is a major cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD); however, temporal trends in the management and clinical outcomes of these patients remain unclear. METHODS AND RESULTS We conducted an observational study by using a representative sample of 1 million beneficiaries from the Taiwan National Health Insurance Research Database. Comorbidities, in-hospital treatment, and outcomes were compared for patients with acute myocardial infarction with and without COPD between 2004 and 2013. Temporal trends in treatment and outcomes were analyzed. We included 6770 patients admitted to hospitals with acute myocardial infarction diagnoses, of whom 1921 (28.3%) had COPD. Fewer patients with COPD received β-blockers (adjusted odds ratio 0.66, 95% CI 0.59-0.74), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (adjusted odds ratio 0.83, 95% CI 0.73-0.93), statins, anticoagulants, dual antiplatelets, and coronary interventions. These patients had higher mortality (in hospital: adjusted hazard ratio 1.25 [95% CI 1.11-1.41]; 1 year: adjusted hazard ratio 1.20 [95% CI 1.09-1.32]) and respiratory failure risk during admission. Temporal trends showed little improvement in mortality in patients with COPD over 10 years. Multivariable logistic regression indicated that dual antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, coronary angiography, and coronary artery bypass grafting surgery were significantly correlated with improved mortality in patients with COPD. CONCLUSIONS In Taiwan, a lower proportion of patients with COPD received evidence-based therapies for acute myocardial infarction than did patients without COPD, and their clinical outcomes were inferior. Limited improvement in mortality was observed over the preceding 10 years and is attributable to the underuse of evidence-based treatments.
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Affiliation(s)
- Tse-Hsuan Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Ling Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
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35
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Coiro S, Girerd N, Rossignol P, Ferreira JP, Maggioni A, Pitt B, Tritto I, Ambrosio G, Dickstein K, Zannad F. Association of beta-blocker treatment with mortality following myocardial infarction in patients with chronic obstructive pulmonary disease and heart failure or left ventricular dysfunction: a propensity matched-cohort analysis from the High-Risk Myocardial Infarction Database Initiative. Eur J Heart Fail 2016; 19:271-279. [PMID: 27774703 DOI: 10.1002/ejhf.647] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/28/2016] [Accepted: 07/11/2016] [Indexed: 12/30/2022] Open
Abstract
AIMS To determine the influence of baseline beta-blocker use on long-term prognosis of myocardial infarction (MI) survivors complicated with heart failure (HF) or with left ventricular dysfunction and with history of chronic obstructive pulmonary disease (COPD). METHODS AND RESULTS Among the 28 771 patients from the High-Risk MI Database Initiative we identified 1573 patients with a baseline history of COPD. We evaluated the association between beta-blocker use at baseline (822 with beta-blocker and 751 without) on the rates of all-cause and cardiovascular mortality. On univariable Cox analysis, beta-blocker use was found to be associated with lower rates of both all-cause [hazard ratio (HR) = 0.61, 95% confidence interval (CI) 0.51-0.75, P < 0.0001] and cardiovascular mortality (HR = 0.63, 95% CI 0.51-0.78, P < 0.0001). After extensive adjustment for confounding, including 24 baseline covariates, COPD patients still benefited from beta-blocker usage (HR = 0.73, 95% CI 0.60-0.90, P = 0.002 for all-cause mortality; HR = 0.77, 95% CI 0.61-0.97, P = 0.025 for cardiovascular mortality). Adjusting for propensity scores (PS) constructed from the 24 aforementioned baseline characteristics provided similar results. In a cohort of 561 pairs of patients taking or not taking beta-blocker matched on PS using a 1:1 nearest-neighbour matching method, patients treated with beta-blocker experienced fewer all-cause deaths (HR = 0.71, 95% CI 0.56-0.89, P = 0.003) and cardiovascular deaths (HR = 0.76, 95% CI 0.59-0.97, P = 0.032). CONCLUSIONS In the specific setting of a well-treated cohort of high-risk MI survivors, beta-blockers were associated with better outcomes in patients with COPD.
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Affiliation(s)
- Stefano Coiro
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.,Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
| | - Patrick Rossignol
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
| | - João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Bertram Pitt
- Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Isabella Tritto
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
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36
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Canepa M, Temporelli PL, Rossi A, Rossi A, Gonzini L, Nicolosi GL, Staszewsky L, Marchioli R, Maggioni AP, Tavazzi L. Prevalence and Prognostic Impact of Chronic Obstructive Pulmonary Disease in Patients with Chronic Heart Failure: Data from the GISSI-HF Trial. Cardiology 2016; 136:128-137. [PMID: 27618363 DOI: 10.1159/000448166] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/30/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure (HF). We aimed to assess its prevalence, characterization and long-term prognostic impact in the GISSI-HF population. METHODS The study randomized 6,975 ambulatory HF patients to either n-3 polyunsaturated fatty acids or placebo. We performed a retrospective analysis of clinical characteristics and outcomes of the 1,533 patients diagnosed with COPD (22%). RESULTS COPD was associated with a worse clinical presentation and an increased burden of comorbidities. At a median follow-up of 3.9 years, COPD was found to be an independent predictor of both predefined primary study end points, including all-cause mortality (HR 1.28, 95% CI 1.15-1.43, p < 0.0001) and all-cause mortality or hospitalization for cardiovascular reasons (HR 1.19, 95% CI 1.10-1.30, p < 0.0001). Both cardiovascular (HR 1.20, 95% CI 1.05-1.36, p = 0.007) and noncardiovascular mortality (HR 1.56, 95% CI 1.26-1.94, p < 0.0001) were significantly increased in COPD-HF patients, as well as hospitalizations for any reason (HR 1.23, 95% CI 1.14-1.34, p < 0.0001), for cardiovascular reasons (HR 1.16, 95% CI 1.06-1.27, p = 0.002) and for HF (HR 1.27, 95% CI 1.14-1.43, p < 0.0001). CONCLUSIONS COPD is an independent predictor of mortality and hospitalizations in ambulatory HF patients. Increased awareness and improved management of COPD may reduce the burden of this morbidity to patients with HF.
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Affiliation(s)
- Marco Canepa
- Cardiovascular Unit, Department of Internal Medicine, IRCCS-AOU San Martino - IST, University of Genoa, Genoa, Italy
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Chong VH, Singh J, Parry H, Saunders J, Chowdhury F, Mancini DM, Lang CC. Management of Noncardiac Comorbidities in Chronic Heart Failure. Cardiovasc Ther 2016; 33:300-15. [PMID: 26108139 DOI: 10.1111/1755-5922.12141] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Prevalence of heart failure is increasing, especially in the elderly population. Noncardiac comorbidities complicate heart failure care and are increasingly common in elderly patients with reduced or preserved ejection fraction heart failure, owing to prolongation of patient's lives by advances in chronic heart failure (CHF) management. Common comorbidities include respiratory disease, renal dysfunction, anemia, arthritis, obesity, diabetes mellitus, cognitive dysfunction, and depression. These conditions contribute to the progression of the disease and may alter the response to treatment, partly as polypharmacy is inevitable in these patients. Cardiologists and other physicians caring for patients with CHF need to be vigilant to comorbid conditions that complicate the care of these patients. There is now more guidance on management of noncardiac comorbidities in heart failure, and this article contains a comprehensive review of the most recent updates on management of noncardiac comorbidities in CHF.
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Affiliation(s)
- Vun Heng Chong
- Department of Cardiology, Ninewells Hospital, Dundee, UK
| | - Jagdeep Singh
- Division of Medicine and Therapeutics, University of Dundee, Dundee, UK
| | - Helen Parry
- Department of Cardiology, Ninewells Hospital, Dundee, UK
| | | | | | - Donna M Mancini
- Department of Medicine, Columbia University, New York City, NY, USA
| | - Chim C Lang
- Department of Cardiology, Ninewells Hospital, Dundee, UK
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38
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Roche N. Adding biological markers to COPD categorisation schemes: a way towards more personalised care? Eur Respir J 2016; 47:1601-5. [DOI: 10.1183/13993003.00401-2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 02/06/2023]
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Staszewsky L, Cortesi L, Tettamanti M, Dal Bo GA, Fortino I, Bortolotti A, Merlino L, Latini R, Roncaglioni MC, Baviera M. Outcomes in patients hospitalized for heart failure and chronic obstructive pulmonary disease: differences in clinical profile and treatment between 2002 and 2009. Eur J Heart Fail 2016; 18:840-8. [PMID: 27098360 DOI: 10.1002/ejhf.519] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/12/2016] [Accepted: 02/27/2016] [Indexed: 12/20/2022] Open
Abstract
AIMS Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently co-exist, and each is a major public health issue. In a large cohort of hospitalized HF patients, we evaluated: (i) the impact of COPD on clinical outcomes; (ii) whether outcomes and treatments changed from 2002 to 2009; and (iii) the relationship between outcomes and treatments focusing on beta-blockers (BBs) and bronchodilators (BDs). METHODS AND RESULTS From linkable Lombardy administrative health databases, we selected individuals with a discharge diagnosis of HF with or without concomitant COPD (HF yesCOPD and HF noCOPD) in 2002 and 2009. Patients were followed up for 4 years. Outcomes were total mortality, first readmission for HF, and their combination. Unadjusted and adjusted Cox proportional models and competing risk analyses were used. We identified 11 274 patients with HF noCOPD and 2837 with HF yesCOPD. HF yesCOPD patients in 2002 and 2009 had a 20% higher risk of the outcomes. From 2002 to 2009, BB and BD prescriptions increased significantly. In HF noCOPD patients, risks for mortality [adjusted hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.86-0.97], first HF readmission (HR 0.79, 95% CI 0.74-0.85), and the combined endpoint (HR 0.88, 95% CI 0.84-0.92) declined (all P < 0.003) while in HF yesCOPD only the risk for first HF readmission dropped (HR 0.86, 95% CI 0.76-0.97; P = 0.018). BBs were associated with significantly lower mortality in both groups, but with a higher risk for first HF readmission in HF noCOPD. Outcomes did not significantly differ in HF yesCOPD treated or not with BDs. CONCLUSIONS The prognosis of patients hospitalized for HF, either with or without COPD, seemed to improve between 2002 and 2009, with possibly better survival of those on BBs. Because of residual confounding in observational studies, a randomized controlled trial should be considered to confirm these results.
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Affiliation(s)
- Lidia Staszewsky
- Laboratory of Cardiovascular Clinical Pharmacology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Laura Cortesi
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Gabrio Andrea Dal Bo
- Unit of Internal and Respiratory Medicine, Fatebenefratelli e Oftalmico Hospital, Milan, Italy
| | - Ida Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | | | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Roberto Latini
- Laboratory of Cardiovascular Clinical Pharmacology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Maria Carla Roncaglioni
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Marta Baviera
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
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Liu Y, Narayanan K, Zhang Z, Li G, Liu T. Chronic obstructive pulmonary disease and risk of sudden cardiac death. Int J Cardiol 2016; 214:406-7. [PMID: 27085657 DOI: 10.1016/j.ijcard.2016.03.216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 03/29/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Yang Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | | | - Zhiwei Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
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Rothnie KJ, Quint JK. Chronic obstructive pulmonary disease and acute myocardial infarction: effects on presentation, management, and outcomes. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:81-90. [PMID: 29474627 PMCID: PMC5862020 DOI: 10.1093/ehjqcco/qcw005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease is a common cause of death in patients with chronic obstructive pulmonary disease (COPD) and is a key target for improving outcomes. However, there are concerns that patients with COPD may not have enjoyed the same mortality reductions from acute myocardial infarction (AMI) in recent decades as the general population. This has raised questions about differences in presentation, management and outcomes in COPD patients compared to non-COPD patients. The evidence points to an increased risk of death after AMI in patients with COPD, but it is unclear to what extent this is attributable to COPD itself or to modifiable factors including under-treatment with guideline-recommended interventions and drugs. We review the evidence for differences between COPD and non-COPD patients in terms of the presentation of AMI, its treatment, and outcomes both in hospital and in the longer term.
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Affiliation(s)
- Kieran J. Rothnie
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, London SW3 6LR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer K. Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, London SW3 6LR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Su VYF, Chang YS, Hu YW, Hung MH, Ou SM, Lee FY, Chou KT, Yang KY, Perng DW, Chen TJ, Liu CJ. Carvedilol, Bisoprolol, and Metoprolol Use in Patients With Coexistent Heart Failure and Chronic Obstructive Pulmonary Disease. Medicine (Baltimore) 2016; 95:e2427. [PMID: 26844454 PMCID: PMC4748871 DOI: 10.1097/md.0000000000002427] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/10/2015] [Accepted: 12/10/2015] [Indexed: 01/11/2023] Open
Abstract
Beta (β)-blockers are under-prescribed in patients with heart failure (HF) and concurrent chronic obstructive pulmonary disease (COPD) due to concerns about adverse pulmonary effects and a poor understanding of the effects of these drugs. We aimed to evaluate the survival effects of β-blockers in patients with coexistent HF and COPD. Using the Taiwan National Health Insurance Research Database, we conducted a nationwide population-based study. Patients with coexistent HF and COPD diagnosed between 2000 and 2009 were enrolled. Doses of the 3 β-blockers proven to be beneficial to HF (carvedilol, bisoprolol, and metoprolol) during the study period were extracted. The primary endpoint was cumulative survival. Patients were followed until December 31, 2009. The study included 11,558 subjects, with a mean follow-up period of 4.07 years. After adjustment for age, sex, comorbidities, and severity of HF and COPD, bisoprolol use showed a dose-response survival benefit [low dose: adjusted hazard ratio (HR) = 0.76, 95% confidence interval (CI) = 0.59-0.97, P = 0.030; high dose: adjusted HR = 0.40, 95% CI = 0.26-0.63, P < 0.001] compared with nonusers, whereas no survival difference was observed for carvedilol or metoprolol. Compared with patients with HF alone, this special HF + COPD cohort received significantly fewer targeted β-blockers (108.8 vs 137.3 defined daily doses (DDDs)/person-year, P < 0.001) and bisoprolol (57.9 vs 70.8 DDDs/person-year, P < 0.001). In patients with coexisting HF and COPD, this study demonstrated a dose-response survival benefit of bisoprolol use, but not of carvedilol or metoprolol use.
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Affiliation(s)
- Vincent Yi-Fong Su
- From the Department of Chest Medicine (VY-FS, K-TC, K-YY, D-WP); Cancer Center (Y-WH); Division of Hematology and Oncology (M-HH, C-JL); Division of Nephrology (S-MO); Division of Gastroenterology, Department of Medicine (F-YL); Department of Family Medicine, Taipei Veterans General Hospital, Taipei (T-JC); Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City (Y-SC); School of Medicine (VY-FS, Y-SC, Y-WH, M-HH, S-MO, F-YL, K-TC, K-YY, D-WP, T-JC, C-JL); Institute of Public Health (M-HH, C-JL); and Institute of Clinical Medicine VY-FS, K-TC, National Yang-Ming University, Taipei, Taiwan
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Utsugi H, Nakamura H, Suzuki T, Maeno T, Nagata M, Kanazawa M. Associations of lifelong cigarette consumption and hypertension with airflow limitation in primary care clinic outpatients in Japan. Respir Investig 2015; 54:35-43. [PMID: 26718143 DOI: 10.1016/j.resinv.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/07/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Underdiagnosis is a critical problem in the management of chronic obstructive pulmonary disease (COPD). It is important to screen patients at risk for COPD among those with lifestyle-related diseases such as hypertension, diabetes mellitus, and dyslipidemia, since these diseases promote the development of cardiovascular diseases closely associated with increased COPD mortality. METHODS Thirteen primary care clinics in a suburb of Tokyo participated in the current study. A total of 950 patients from these clinics were enrolled in the study between 2010 and 2012; the patients ranged in age from 40 to 79 years, and they had no diagnosed respiratory diseases at the time of enrollment. Patients fulfilling the selection criteria were recruited to undergo spirometry and then completed a self-report questionnaire about comorbid diseases and smoking habits. Spirometry was performed 15 min after inhalation of 200 μg of salbutamol sulfate. RESULTS The prevalence of airflow limitation was 12.7% in the 950 primary care clinic patients. Lifelong cigarette consumption was the most significant risk factor for airflow limitation, e.g., patients who smoked 60 pack-years or more had a 40% likelihood of airflow limitation. Among common lifestyle-related diseases, hypertension was associated with the severity of airflow limitation (p=0.03), whereas dyslipidemia appeared to be inversely correlated with the severity of airflow limitation (p=0.004) on multiple regression analysis including lifelong cigarette consumption as a factor. CONCLUSIONS Undiagnosed airflow limitation was detected in 12.7% of outpatients at the primary care clinics. Since most patients with lifestyle-related diseases are treated by primary care physicians, it is essential for the physicians to obtain an accurate history of smoking and comorbid diseases to screen patients for COPD.
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Affiliation(s)
- Harue Utsugi
- Department of Respiratory Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
| | - Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
| | - Tomoko Suzuki
- Department of Respiratory Medicine, Aizu Medical Center, Fukushima Medical University, 21-2 Kawato-machi, Yazawa aza Maeda, Aizuwakamatsu, Fukushima 969-3492, Japan.
| | - Toshitaka Maeno
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan.
| | - Makoto Nagata
- Department of Respiratory Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
| | - Minoru Kanazawa
- Department of Respiratory Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
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Rothnie KJ, Yan R, Smeeth L, Quint JK. Risk of myocardial infarction (MI) and death following MI in people with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. BMJ Open 2015; 5:e007824. [PMID: 26362660 PMCID: PMC4567661 DOI: 10.1136/bmjopen-2015-007824] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1) risk of myocardial infarction (MI) in people with COPD; (2) risk of MI associated with acute exacerbation of COPD (AECOPD); (3) risk of death after MI in people with COPD. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates, where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible. RESULTS Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42) for cohort analyses, but not in case-control studies: OR 1.18 (0.80 to 1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (incidence rate ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7). Meta-analysis showed weak evidence for increased risk of death for patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However, meta-analysis showed an increased risk of death after MI for patients with COPD during follow-up (HR 1.26, 1.13 to 1.40). CONCLUSIONS There is good evidence that COPD is associated with increased risk of MI; however, it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in hospital mortality after an MI, and good evidence that longer term mortality is higher for patients with COPD after an MI.
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Affiliation(s)
- Kieran J Rothnie
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruoling Yan
- Medical School, Faculty of Medical Sciences, University College London, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Alter P, van de Sand K, Nell C, Figiel JH, Greulich T, Vogelmeier CF, Koczulla AR. Airflow limitation in COPD is associated with increased left ventricular wall stress in coincident heart failure. Respir Med 2015; 109:1131-7. [DOI: 10.1016/j.rmed.2015.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 01/08/2023]
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Narayanan K, Reinier K, Uy-Evanado A, Teodorescu C, Zhang L, Chugh H, Nichols GA, Gunson K, Jui J, Chugh SS. Chronic Obstructive Pulmonary Disease and Risk of Sudden Cardiac Death. JACC Clin Electrophysiol 2015; 1:381-387. [PMID: 29759465 DOI: 10.1016/j.jacep.2015.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/17/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether chronic obstructive pulmonary disease (COPD) is associated with sudden cardiac death (SCD) in the community. BACKGROUND COPD is linked to cardiovascular mortality; an association with SCD has not been systematically investigated in the general population. METHODS In the Oregon Sudden Unexpected Death Study (approximately 1 million population), adult SCD case subjects were compared with geographic control subjects with coronary artery disease. Detailed clinical and electrocardiographic risk marker information was obtained from medical records. The association of COPD with SCD in the overall population and in a propensity score-matched dataset was assessed with logistic models. RESULTS SCD case subjects (n = 728; age 69.9 ± 13.7 years) were more likely than control subjects (n = 548; age 67.2 ± 11.3 years) to have left ventricular ejection fraction ≤35% (27.5% vs. 12.0%; p < 0.0001), COPD (30.8% vs. 12.8%, p < 0.0001), diabetes mellitus (47.7% vs. 31.8%; p < 0.0001), use short-acting beta-2 agonist agents (SBAs) (22.3% vs. 12.6%; p < 0.0001), and less likely to use beta-blockers (60.6% vs. 66.4%; p = 0.03). In multivariable analysis, COPD was significantly associated with SCD (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.4 to 3.5; p < 0.001). There was no significant interaction between COPD and medications, but an interaction was identified between SBAs and beta-blockers (p = 0.04); SBAs were strongly associated with SCD in subjects not taking beta-blockers (OR: 3.3; 95% CI: 1.4 to 7.7; p = 0.005) but not in those taking beta-blockers (OR: 1.3; 95% CI: 0.7 to 2.3; p = 0.39). The COPD-SCD association was maintained in a propensity score-matched analysis. CONCLUSIONS COPD is associated with SCD risk in the community independent of medications, electrocardiographic risk markers, and left ventricular ejection fraction. Among other mechanisms, pro-arrhythmogenic right ventricular remodeling and systemic inflammation warrant further investigation.
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Affiliation(s)
- Kumar Narayanan
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kyndaron Reinier
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Audrey Uy-Evanado
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carmen Teodorescu
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lin Zhang
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Harpriya Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Karen Gunson
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Straburzyńska-Migaj E, Kałużna-Oleksy M, Maggioni AP, Grajek S, Opolski G, Ponikowski P, Jankowska E, Balsam P, Poloński L, Drożdż J. Patients with heart failure and concomitant chronic obstructive pulmonary disease participating in the Heart Failure Pilot Survey (ESC-HF Pilot) - Polish population. Arch Med Sci 2015; 11:743-50. [PMID: 26322085 PMCID: PMC4548022 DOI: 10.5114/aoms.2014.47878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/17/2014] [Accepted: 06/05/2014] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION There is an increasing interest in comorbidities in heart failure patients. Data about chronic obstructive pulmonary disease (COPD) in the Polish population of heart failure (HF) patients are scarce. The aim of this study was to investigate the clinical characteristics, treatment differences and outcome according to COPD occurrence in the Polish population of patients participating in the ESC-HF Pilot Survey Registry. MATERIAL AND METHODS We analyzed the data of 891 patients with HF recruited in 2009-2011 in Poland: 648 (72.7%) hospitalized patients and 243 (27.3%) patients included as outpatients. RESULTS The COPD was documented in 110 (12.3%) patients with HF in the analyzed population. Patients with - compared to those without COPD were older, more often smokers, had higher NYHA class, and higher prevalence of hypertension. Ejection fraction (EF) was higher in hospitalized patients with COPD compared to patients without COPD (40.5 ±14.6% vs. 37.2 ±13.7%, p < 0.04), without a significant difference in the outpatient group. There was a significant difference in β-blocker use between patients with and without COPD (81.8% vs. 94.7%, p < 0.0001). Most patients received them below target doses. At the end of the 12-month follow-up, there was no significant difference in mortality between COPD and no-COPD patients (10.9% vs. 11.1%, p = 0.66). CONCLUSIONS The findings from the Polish part of the ESC-HF registry indicate that COPD in patients with HF is associated with older age, smoker status, hypertension and higher NYHA class. The use of β-blockers was significantly lower in patients with than without COPD. There were no significant differences in mortality between groups.
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Affiliation(s)
- Ewa Straburzyńska-Migaj
- 1 Department of Cardiology, University Hospital “Przemienienia Pańskiego”, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Kałużna-Oleksy
- 1 Department of Cardiology, University Hospital “Przemienienia Pańskiego”, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Stefan Grajek
- 1 Department of Cardiology, University Hospital “Przemienienia Pańskiego”, Poznan University of Medical Sciences, Poznan, Poland
| | - Grzegorz Opolski
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Ponikowski
- Department of Cardiology, 4 Military Hospital, Medical University of Wroclaw, Wroclaw, Poland
| | - Ewa Jankowska
- Department of Cardiology, 4 Military Hospital, Medical University of Wroclaw, Wroclaw, Poland
| | - Paweł Balsam
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Lech Poloński
- 3 Chair and Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Medical Faculty in Zabrze, Poland
| | - Jarosław Drożdż
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
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Almagro P, Lapuente A, Pareja J, Yun S, Garcia ME, Padilla F, Heredia JLI, De la Sierra A, Soriano JB. Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study. Int J Chron Obstruct Pulmon Dis 2015. [PMID: 26213464 PMCID: PMC4509531 DOI: 10.2147/copd.s84482] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Retrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD - previously or newly diagnosed - in patients with IHD treated with PCI. METHODS Patients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed. RESULTS A total of 133 patients (78%) male, with a mean (SD) age of 63 (10.12) years were included. Of these, 33 (24.8%) met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%-75%]: 546-1,160). COPD patients had greater mortality (P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76-44.47) and number of cardiovascular events (P=0.024; HR: 1.87; 95% CI: 1.04-3.33), even those without a previous diagnosis of COPD (P=0.01; HR: 1.78; 95% CI: 1.12-2.83). These differences remained after adjustment for sex, age, number of coronary vessels affected, and previous myocardial infarction (P=0.025; HR: 1.83; 95% CI: 1.08-3.1). CONCLUSION Prevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients have an independent greater mortality and a higher number of cardiovascular events during follow-up.
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Affiliation(s)
- Pere Almagro
- Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Anna Lapuente
- Pneumology Service, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Julia Pareja
- Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Sergi Yun
- Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain
| | | | - Ferrán Padilla
- Cardiology Service, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Josep L I Heredia
- Pneumology Service, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Alex De la Sierra
- Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Joan B Soriano
- Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid, Madrid, Spain
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Lahousse L, Niemeijer MN, van den Berg ME, Rijnbeek PR, Joos GF, Hofman A, Franco OH, Deckers JW, Eijgelsheim M, Stricker BH, Brusselle GG. Chronic obstructive pulmonary disease and sudden cardiac death: the Rotterdam study. Eur Heart J 2015; 36:1754-61. [PMID: 25920404 DOI: 10.1093/eurheartj/ehv121] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/24/2015] [Indexed: 02/05/2023] Open
Abstract
AIMS Both sudden cardiac death (SCD) and chronic obstructive pulmonary disease (COPD) are common conditions in the elderly. Previous studies have identified an association between COPD and cardiovascular disease, and with SCD in specific patient groups. Our aim was to investigate whether there is an association between COPD and SCD in the general population. METHODS AND RESULTS The Rotterdam study is a population-based cohort study among 14 926 subjects aged 45 years and older with up to 24 years of follow-up. Analyses were performed with a (time dependent) Cox proportional hazard model adjusted for age, sex, and smoking. Of the 13 471 persons included in the analysis; 1615 had a diagnosis of COPD and there were 551 cases of SCD. Chronic obstructive pulmonary disease was associated with an increased risk of SCD (age- and sex-adjusted hazard ratio, HR, 1.34, 95% CI 1.06-1.70). The risk particularly increased in the period 2000 days (5.48 years) after the diagnosis of COPD (age- and sex-adjusted HR 2.12, 95% CI 1.60-2.82) and increased further to a more than three-fold higher risk in COPD subjects with frequent exacerbations during this period (age- and sex-adjusted HR 3.58, 95% CI 2.35-5.44). Analyses restricted to persons without prevalent myocardial infarction or heart failure yielded similar results. CONCLUSION Chronic obstructive pulmonary disease is associated with an increased risk for SCD. The risk especially increases in persons with frequent exacerbations 5 years after the diagnosis of COPD. This risk indicator could provide new directions for better-targeted actions to prevent SCD.
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Affiliation(s)
- Lies Lahousse
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Maartje N Niemeijer
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Marten E van den Berg
- Department of Medical Informatics, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Guy F Joos
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Mark Eijgelsheim
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Internal Medicine, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Internal Medicine, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Inspectorate of Healthcare, The Hague, The Netherlands
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Respiratory Medicine, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
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[Medical therapy of heart and lung diseases. Effects on the respective other organ]. Herz 2015; 39:15-24. [PMID: 24452761 DOI: 10.1007/s00059-013-4035-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Many patients suffer from both heart and lung diseases. The choice of medical drugs should not only be driven by the clinical and prognostic effects on the target organ but should also be selected based on the effects on the respective other organ. Beta blockers and statins have both beneficial and harmful effects on the respiratory system. Angiotensin-converting enzyme (ACE) inhibitors and amiodarone can cause severe lung damage. Low-dose thiazides and calcium antagonists are first-line medications in hypertensive asthma patients but beta blockers should be avoided. Theophyline should be used with caution in patients with known cardiac disease. Glucocorticosteroids can cause cardiovascular symptoms while the phosphodiesterase inhibitor roflumilast appears to have no relevant cardiovascular side effects. Anticholinergic drugs have both favorable and unfavorable cardiovascular (side) effects. Short-acting beta-2 sympathomimetic drugs (SABA) and macrolides in particular can trigger arrhythmia and some SABAs are associated with a higher incidence of myocardial infarction. Detailed knowledge of the effects of drugs used for the treatment of lung and heart diseases on the respective other organ and the associated complications and long-term effects are essential in providing optimal medical care to the many patients who present with both respiratory and cardiovascular diseases.
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