Prognostic Impact of Chronic Obstructive Pulmonary Disease in Patients with Heart Failure with Mildly Reduced Ejection Fraction

Clin Res Cardiol (2024). DOI 10.1007/s00392-024-02406-5
T. Schupp (Mannheim)¹, A. Schmitt (Mannheim)¹, F. Lau (Mannheim)¹, M. Reinhardt (Mannheim)¹, N. Abel (Mannheim)¹, M. Abumayyaleh (Mannheim)¹, K. J. Weidner (Mannheim)¹, M. Ayoub (Bad Oeynhausen)², K. A. Mashayekhi (Lahr/Schwarzwald)³, M. Akin (Hannover)⁴, I. Akin (Mannheim)¹, M. Behnes (Mannheim)^1
1Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; ²Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; ³MediClin Herzzentrum Lahr/Baden Innere Medizin und Kardiologie Lahr/Schwarzwald, Deutschland; ⁴Medizinische Hochschule Hannover Kardiologie und Angiologie Hannover, Deutschland

Objective: The study investigates the prognostic impact of chronic obstructive pulmonary disease (COPD) in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF).
Background: Studies examining the prognostic impact of COPD in HFmrEF are limited.
Methods: Consecutive patients with HFmrEF (i.e., left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. Patients with COPD were compared to patients without regarding the primary endpoint was all-cause mortality at 30 months (median follow-up). Secondary endpoints comprised in-hospital mortality, HF-related rehospitalization, cardiac rehospitalization and major adverse cardiac and cerebrovascular events (MACCE) at 30 months. Kaplan-Meier, multivariable Cox proportional regression analyses and propensity score matched analyses were applied for statistics.

Results: A total of 2,184 patients with HFmrEF were included with a prevalence of COPD of 12.0%. Patients with COPD were older (median 77 vs. 75 years; p = 0.025), had increased burden of cardiovascular comorbidities and more advanced HF symptoms. At 30 months, patients with COPD had an increased risk of all-cause mortality compared to patients without (45% vs. 30%; HR = 1.667; 95% CI 1.366 – 2.034; p = 0.001), alongside with a higher risk of rehospitalization for worsening HF (20% vs. 12%; HR = 1.658; 95% CI 1.218 – 2.257; p = 0.001). Specifically, the need for long-term oxygen therapy indicated higher risk of 30-months all-cause mortality (61.0% vs. 41.4%; log rank p = 0.017).

Conclusion: COPD is independently associated with adverse outcomes in patients hospitalized with HFmrEF.