Author + information
- Solmaz Ehteshami-Afshar,
- Nathaniel M. Hawkins,
- Jean Rouleau,
- Karl Swedberg,
- Michael Zile,
- Martin Lefkowitz,
- Victor Shi,
- Scott Solomon,
- Milton Packer and
- John McMurray
Background: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in heart failure (HF), may further activate the natriuretic peptide system, and has been associated with under-treatment and worse prognosis.
Methods: We examined the outcomes of patients with HF and COPD receiving contemporary medical therapy in 8399 patients with HF and reduced ejection fraction in the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM-HF). Cox regression models were used to compare COPD (n=1080, 12.9%) vs non-COPD subgroups, and sacubitril/valsartan vs enalapril treatment effects.
Results: Patients with COPD compared to without COPD were older, with similar ejection fraction (29.4% vs 29.9% respectively), but had significantly higher baseline NT-proBNP levels (median 3285 vs 2840 pg/ml), worse functional class (NYHA III 36% vs 22%), and more frequent cardiovascular risk factors and disease, including atrial fibrillation (45% vs 37%), angina (29% vs 20%), previous myocardial infarction (48% vs 43%), and percutaneous coronary intervention (26% vs 21%). Medical therapy was similar in patients with and without COPD (aldosterone antagonist 54% vs 56%, digoxin 30% vs 30%), with the exception of beta-blockade (87% vs 94%) and diuretics (85% vs 80%). In unadjusted analyses, COPD was associated with increased risk of all endpoints. However, after multivariable adjustment COPD was only associated with increased risk of HF hospitalization (hazard ratio 1.27 [95% CI 1.08-1.49]), but not the composite endpoint of cardiovascular (CV) death or HF hospitalization (1.14 [1.00-1.29]), CV death (1.04 [0.87-1.23]), or all-cause mortality (1.07 [0.93-1.25]). The benefit of sacubitril/valsartan compared to enalapril was consistent across all endpoints in patients with COPD compared to those without (all tests for interaction non-significant).
Conclusions: COPD in patients with HF and reduced ejection fraction is associated with increased burden of comorbidities and lower use of beta-blockade. In this large, optimally treated clinical trial population COPD was an independent predictor of HF hospitalization but not mortality.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-278
- 2017 American College of Cardiology Foundation