COPD May Increase Risk of All-Cause Mortality Among Patients With Heart Failure

Chronic obstructive pulmonary disease (COPD) may increase the risk of all-cause mortality for patients with heart failure (HF), according to pooled data of 18 studies.

The overlap of HF and COPD is not uncommon, as 10% to 20% of patients with HF also have comorbid COPD, according to randomized controlled trials and observational studies. While previous research has suggested patients with COPD have an increased risk of death when they also receive a diagnosis of HF, the impact of a COPD diagnosis on patients with HF is less certain.

The current meta-analysis includes data on the impact of COPD on patients hospitalized with HF, as well as patients with chronic HF.A total of 9 studies offered mortality data on hospitalized patients with HF and COPD compared with hospitalized patients with HF without the disease.

While COPD did not increase the risk of in-hospital mortality (Risk ratio [RR] 1.03, 95% Confidence interval [CI]: 0.91-1.17), the disease did increase post-discharge all-cause mortality (RR 1.43, 95% CI: 1.20-1.70) and post-discharge cardiovascular mortality (RR 1.26, 95% CI: 0.91-1.74).

Ten studies provided comparative data on mortality and hospitalizations among chronic HF patients with comorbid COPD and chronic HF patients without COPD. The compiled data showed that COPD significantly heightened the risk of all-cause mortality (RR 1.24, 95% CI: 1.16-1.33), although the disease did not significantly alter the risk of cardiovascular mortality (RR 1.08, 95% CI: 0.97-1.21).

“Moreover, the risk of post-discharge all-cause mortality increased with time of follow-up (Pinteraction=.02)” among patients with hospitalized HF. “Among patients with chronic HF, the risk of all-cause mortality also increased with time of follow-up (Pinteraction=.01). Therefore, our meta-analysis suggested that COPD comorbidity could increase the risk of long-term all-cause mortality of HF patients,” researchers said.

When it came to risk of hospitalization, concurrent COPD was associated with significant increases in risk of all-cause hospitalization (RR 1.31, 95% CI: 1.21-1.42; I2=53%) and HF hospitalization (RR 1.31, 95% CI: 1.21-1.42; I2=0%).

Researches noted the results should be “interpreted cautiously,” due to the limiting studies on hospitalization that were included in the analysis.

Pooled data on the impact of COPD on HF by subgroup showed that HF patients with reduced ejection fraction (HFrEF) fared worse than HF patients with preserved ejection fraction (HFpEF). Concurrent COPD led to a significantly higher RR in patients with hospitalized HFrEF (RR 1.24, 95% CI: 1.02-1.50) and chronic HFrEF (RR1.21, 95% CI: 1.13-1.30), while there were no significant differences in hospitalized and chronic HFpEF patients who also received a COPD diagnosis (RR 4.17, 95% CI: 0.60-28.84 and RR 1.36, 95% CI: 0.98-1.90, respectively).

“Of note, we only included two studies to pool the data of all-cause mortality for HFpEF patients,”researchers said. “Therefore, the relevant results of HFpEF patients should be interpreted cautiously. Nevertheless, a post-hoc analysis of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial has concluded that pulmonary disease (COPD or asthma) could not predict the risk of all-cause mortality in HFpEF patients.”

Reference: Xu S, Ye Z, Ma J, and Yuan T. The impact of chronic obstructive pulmonary disease on hospitalization and mortality in patients with heart failure. Eur J Clin Investig. Published online September 11, 2020. doi: 10.1111/ECI.13402