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COPD and Heart failure (HF) often coexist and each contributes to worse outcomes. The exact prevalence of COPD in a HF population depends on the population studied but is lower in HF clinical trial databases compared to hospital-based studies. Moreover, few studies have reported how COPD affects outcomes in patients with HF, particularly in the African-Americans (AA). We examined the impact of COPD in AAs with HF in the African-American Heart Failure Trial (A-HeFT).
A-HeFT randomized 1050 patients with NYHA class Ill-IV HF to a fixed dose combination of isosorbide dinitrate plus hydralazine or placebo, in addition to standard therapy including beta-blockers (83%), diuretics (92%) and ACEI or ARB (93%) aldosterone antagonist (40%) and digoxin (60%). A multivariable Cox proportional hazard model was used to test the impact of COPD on outcomes.
COPD by history was present in 19% of subjects at baseline. As compared with those without COPD, patients with COPD were older, more likely to be male, current smokers, less likely to be receiving beta-blocker (68.66% vs. 86.34%, p=<0.001) but more likely to be on ACEI or ARB (93.88% vs. 87.56%, p= 0.002). In a multi-variable Cox analysis, COPD remained significantly associated with all-cause mortality (HR: 1.66; 95% Cl: 1.04-2.67; p=0.035), non-cardiovascular (CV) mortality (HR: 4.7; 95% Cl: 1.56-14.11; p=0.006), all-cause hospitalizations (HR: 1.32; 95% Cl: 1.04-1.68; p=0.023), with a trend towards increased risk of sudden death (HR: 1.91; 95% Cl: 0.94-3.86; p=0.074).
COPD was common in A-HeFT and was an independent predictor of all-cause mortality, non-CV mortality and all-cause hospitalizations in the AA patients with HF. Although the prognostic impact of COPD has been described in hospital based cohort studies, there is limited data in an outpatient based clinical trial setting since these patients are often excluded. Our analysis suggests excess mortality in patients with heart failure and COPD that may be attributed to increased risk of non-cardiovascular death. To the best our knowledge this is one of only two HF clinical trial studies to examine outcomes data in patients with HF and COPD, and the only one in AAs.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Role of Comorbidities in Heart Failure: From Diabetes, Pulmonary Disease, Hypertension to Atrial Fibrillation
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1263-280
- 2013 American College of Cardiology Foundation