COPD in chronic heart failure: Less common than previously thought?

Minasian, Armine G.; Elshout, Frank J.J. van den; Dekhuijzen, P.N.R.; Vos, Petra J.E.; Willems, Frank F.; Bergh, Paul J.P.C. van den; Heijdra, Yvonne F.

doi:10.1016/j.hrtlng.2013.07.002

Cited by 29 publications

(32 citation statements)

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“…Recently, two similar sized studies have shown that the airflow obstruction observed in patients with HF is dynamic and that serial measurements is mandatory to minimize the risk of false positive COPD diagnoses [10, 11]. The four minor studies were all in smaller and/or selected populations (118–187 patients) [7, 8, 20, 21]. None of the studies have performed serial spirometry and only one study used cut-off values for FEV 1 /FVC other than a fixed value of 0.7, which might overestimate the prevalence of airflow obstruction in an older population [7, 22].…”

Section: Discussionmentioning

confidence: 99%

“…Studies of patients with HF have shown a prevalence of self-reported COPD of 10–33% [1, 3, 6] and studies of spirometry in patients with HF have shown an even higher prevalence of COPD (30–39%). However, most of these studies were either small [7, 8] or performed on patients with acute HF [9]. Recently, two larger studies suggest that spirometry might overestimate the presence of COPD in patients with heart failure and that the dynamic nature of lung function makes serial assessment mandatory [10, 11].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of airflow obstruction in patients with stable systolic heart failure

et al. 2017

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BackgroundChronic obstructive pulmonary disease (COPD) is an important differential diagnosis in heart failure (HF). However, routine use of spirometry in outpatient HF clinics is not implemented. The aim of the present study was to determine the prevalence of both airflow obstruction and non obstructive lung function impairment in patients with HF and to examine the effect of optimal medical treatment for HF on lung function parameters.MethodsConsecutive patients with HF (ejection fraction (EF) < 45%) and New York Heart Association (NYHA) functional class II-IV at 10 different outpatient heart failure clinics were examined with spirometry at their first visit and after optimal medical treatment for HF was achieved. airflow obstruction was classified and graded according to the GOLD 2011 revision.ResultsBaseline spirometry was performed in 593 included patients and 71 (12%) had a clinical diagnosis of COPD. Mean age was 69 ± 11 years and mean EF was 30 ± 9%. Thirty-two % of the patients were active smokers and 53% were previous smokers. Mean FEV1 and FVC was 77.9 ± 1.7% and 85.4 ± 1.5% of predicted respectively. Obstructive pattern was observed in 233 (39%) of the patients. Of these, 53 patients (9%) had mild disease (GOLD I) and 180 (30%) patients had moderate to very severe disease (GOLD II-IV). No difference in spirometric variables was observed following up titration of medication.ConclusionIn stable patients with HF airflow obstruction is frequent and severely underdiagnosed. Spirometry should be considered in all patients with HF in order to improve diagnosis and treatment for concomitant pulmonary disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of airflow obstruction in patients with stable systolic heart failure

et al. 2017

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“…In the analysis by Matusik et al [5] in the POLKARD Project -National Project of Prevention and Treatment of Cardiovascular Disease -pulmonary disorders (COPD and asthma) occurred in octogenarians with CHF in a similar percentage: 25.3%. Overall, it is estimated that lung diseases burden CHF in 20--35% [6] of cases and frequently lead to exacerbations of CHF, resignation of beta-blockers, and/or not reaching the target dose [4] and worsening the prognosis. On the basis of a large Norwegian registry of 4132 patients with HF from 22 hospitals, De Blois et al [7] documented that COPD is a predictor of all-cause mortality in 13.3 months of follow-up (hazard ratio [HR] = 1.19; 95% CI 1.015-1.391; p = 0.03).…”

Section: Discussionmentioning

confidence: 99%

Annual prognostic factors in chronic heart failure in patients over 80 years old

Cichocka-Radwan

Lelonek

2017

Kardiol Pol

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A b s t r a c tBackground: In the elderly the most common cause of hospitalisation and the leading cause of death is heart failure (HF). Aim:The purpose was to determine prognostic factors in chronic HF (CHF) in octogenarians and nonagenarians.Methods: The analysis included 197 consecutive patients over 80 years old (mean age 83.63 ± 3.01 years; 46.19% men) hospitalised in 2010-2013 due to CHF. Sixty-two parameters were investigated, such as: age, gender, New York Heart Association functional class, body mass index, blood pressure, other comorbidities, the parameters of the 12-lead resting electrocardiography and the echocardiography, the results of basic laboratory tests, and selected biomarkers, including N-terminal pro-B-type natriuretic peptide, high-sensitive troponin T (hs-TnT), and high-sensitive C-reactive protein. Participants remained in a prospective follow-up for 12 months. We defined the primary endpoint as death due to cardiovascular causes and the composite endpoint, which consisted of: death due to cardiovascular causes and/or hospitalisation for exacerbation of CHF. Follow-up concerning the deaths was performed in 189 patients, composite endpoint in 168 and hospitalisation in 166. The uni-and multivariate logistic regression stepwise analysis was performed for the entire population, according to left ventricular ejection fraction (LVEF < 45% and ≥ 45%) and in the group with glomerular filtration rate (GFR) < 60 mL/min. Results:Patients who died constituted 11.1% of the study population (21/189). In multivariate analysis four variables were independently associated with the primary endpoint: GFR (OR = 0.92), hypertension (OR = 0.19), lung diseases (OR = 9.36), and vascular diseases (OR = 6.07). In turn, in the group of patients who reached the composite endpoint (55/168; 32.7%), the only statistically significant independent variable was anaemia (OR = 4.71). In the subpopulation of patients with LVEF < 45% the prognostics for each endpoint were vascular diseases and lung diseases, and they increased the risk from 10-to 24-fold. In the subgroup of patients with LVEF ≥ 45% the independent variable associated with the composite endpoint was haemoglobin (OR = 0.61), in turn for death the prognostics were: white blood cell count, hs-TnT, and vascular diseases (respectively OR = 1.30; OR = 1.04; OR = 3.96). In the population with GFR < 60 mL/min variables with prognostic importance for the composite endpoint were red blood cell parameters: red blood cell distribution width (OR = 1.42) and anaemia (OR = 3.79), while for occurrence of death they were the same as for the entire population -vascular (OR = 5.16) and lung diseases (OR = 4.72). Conclusions:In patients over 80 years old with CHF, comorbidities are of important prognostic value for annual prognosis. The most aggravating factor in studied subgroups was lung disease.

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“…The use of FEV1/FVC <70% (FR + LLN − ) has been suggested to overdiagnose airflow obstruction in the elderly and underdiagnose in the young as this criterion is heavily influenced by age [15,26]. It has also been suggested that the LLN of the FEV1/FVC ratio is a more useful tool in identifying those with clinically relevant airflow obstruction [13,[26][27][28][29][30]. However, there could be a reason to use broader criteria for the purpose of prediction and prevention of future COPD hospitalisations.…”

Section: Discussionmentioning

confidence: 99%

Lung function, forced expiratory volume in 1 s decline and COPD hospitalisations over 44 years of follow-up

2015

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The use of baseline lung function in the prediction of chronic obstructive pulmonary disease (COPD) hospitalisations, all-cause mortality and lung function decline was assessed in the population-based "Men Born in 1914" cohort.Spirometry was assessed at age 55 years in 689 subjects, of whom 392 had spirometry reassessed at age 68 years. The cohort was divided into three groups using fixed ratio (FR) and lower limit of normal (LLN) LLN− group should be carefully evaluated in clinical practice in relation to future risks and potential benefit from early intervention. This is reinforced by the increased FEV1 decline in this group. @ERSpublications Life-time risk of COPD hospitalisations is strongly related to FEV1/VC <70% and

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COPD in chronic heart failure: Less common than previously thought?

Abstract: One fifth, rather than one third, of the patients with chronic HF had concomitant COPD using the LLN instead of the fixed ratio. LLN may identify clinically more important COPD than a fixed ratio of 0.7.

Cited by 29 publications

References 50 publications

Prevalence of airflow obstruction in patients with stable systolic heart failure

Prevalence of airflow obstruction in patients with stable systolic heart failure

Annual prognostic factors in chronic heart failure in patients over 80 years old

Lung function, forced expiratory volume in 1 s decline and COPD hospitalisations over 44 years of follow-up

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