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

Tobias 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.

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