Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Cardiol. Mar 26, 2012; 4(3): 66-71
Published online Mar 26, 2012. doi: 10.4330/wjc.v4.i3.66
Short-term outcomes in heart failure patients with chronic obstructive pulmonary disease in the community
Noel O’Kelly, William Robertson, Jude Smith, Jonathan Dexter, Collette Carroll-Hawkins, Sudip Ghosh
Noel O’Kelly, Community Health Services, Leicestershire Partnership Trust, Melton, Leicestershire, Le13 1SJ, United Kingdom
Jude Smith, Jonathan Dexter, Collette Carroll-Hawkins, Sudip Ghosh, Community Health Services, Leicestershire County and Rutland Community Health Services, Melton, Leicestershire, Le13 1SJ, United Kingdom
William Robertson, Sudip Ghosh, University of Leicester College of Medicine, University Hospitals Leicester, Leicester, LE1 7RH, United Kingdom
Author contributions: Each author has contributed equally in the concept, preparation and writing of the manuscript; Ghosh S is the guarantor of the paper.
Correspondence to: Sudip Ghosh, PhD, Lecturer/Honorary HF Physician, University of Leicester College of Medicine, University Hospitals Leicester, Leicester, LE1 7RH, United Kingdom. sg168@le.ac.uk
Telephone: +44-7546629428 Fax: +44-7546629428
Received: July 6, 2011
Revised: March 6, 2012
Accepted: March 13, 2012
Published online: March 26, 2012
Abstract

AIM: To establish the short term outcomes of heart failure (HF) patients in the community who have concurrent chronic obstructive pulmonary disease (COPD).

METHODS: We evaluated 783 patients (27.2%) with left ventricular systolic dysfunction under the care of a regional nurse-led community HF team between June 2007 and June 2010 through a database analysis.

RESULTS: One hundred and one patients (12.9%) also had a diagnosis of COPD; 94% of patients were treated with loop diuretics, 83% with angiotensin converting enzyme inhibitors, 74% with β-blockers; 10.6% with bronchodilators; and 42% with aldosterone antagonists. The mean age of the patients was 77.9 ± 5.7 years; 43% were female and mean New York Heart Association class was 2.3 ± 0.6. The mean follow-up was 28.2 ± 2.9 mo. β-blocker utilization was markedly lower in patients receiving bronchodilators compared with those not taking bronchodilators (overall 21.7% vs 81%, P < 0.001). The 24-mo survival was 93% in patients with HF alone and 89% in those with both comorbidities (P = not significant). The presence of COPD was associated with increased risk of HF hospitalization [hazard ratio (HR): 1.56; 95% CI: 1.4-2.1; P < 0.001] and major adverse cardiovascular events (HR: 1.23; 95% CI: 1.03-1.75; P < 0.001).

CONCLUSION: COPD is a common comorbidity in ambulatory HF patients in the community and is a powerful predictor of worsening HF. It does not however appear to affect short-term mortality in ambulatory HF patients.

Keywords: Heart failure; Chronic obstructive pulmonary disease; Short-term mortality