Outcomes differ in patients with coexisting COPD and heart failure, based on phenotype

Outcomes among patients with coexisting COPD and heart failure with preserved ejection fraction were largely driven by COPD, with more acute exacerbations than in those with other types of heart failure, researchers reported.

“The impact of left ventricular ejection fraction heart failure phenotype is poorly described in patients with COPD but may have relevant implications for treatment planning,” Claudia Gulea, MSc, PhD student at the National Heart and Lung Institute at Imperial College London and the NIHR Imperial Biomedical Research Centre, London, and colleagues wrote in the Annals of the American Thoracic Society.

Researchers identified 5,419 patients with COPD and heart failure (HF; median age, 74 years; 50.1% men) from the U.S. administrative claims database OptumLabs DataWarehouse from 2008 to 2018. Gulea and colleagues compared data on all-cause and cause-specific HF hospitalizations, acute exacerbation of COPD, mortality and health care resource use between those with HF with preserved ejection fraction (HFpEF), HF with reduced ejection fraction (HFrEF) and HF with midrange ejection fraction (HFmrEF).

Seventy percent of patients had HFpEF, 20% had HFrEF and 10% had HFmrEF.

There was no difference in all-cause hospitalizations between the three groups. However, compared with patients with COPD and HFpEF, patients with COPD and HFrEF had a greater risk for HF-specific hospitalization (HR = 1.54; 95% CI, 1.29-1.84) and mortality (HR = 1.17; 95% CI, 1.03-1.33).

Patients with COPD and HFrEF also had lower risk for acute exacerbation of COPD compared with patients with COPD and HFpEF (HR = 0.75; 95% CI, 0.66-0.87).

Researchers observed lower rates of long-term stays in skilled nursing facilities and ED visits among patients with COPD and HFrEF compared with patients with COPD and HFpEF.

“While improvements have been observed with emerging therapies such as SGLT2 inhibitors and sacubitril/valsartan (Entresto, Novartis) for subgroups of patients with HFpEF, management strategies to treat the significant multimorbidity burden in these patients are still needed,” the researchers wrote. “A more comprehensive primary care assessment to differentiate between cardiac and respiratory symptoms with greater precision and emphasis on the recognition and management of COPD, may provide an opportunity to reduce acute exacerbations of COPD and improve outcomes for these patients.”