The Impact of Chronic Obstructive Pulmonary Disease in Patients Hospitalized for Worsening Heart Failure With Reduced Ejection Fraction: An Analysis of the EVEREST Trial

Background: Chronic obstructive pulmonary disease (COPD) is prevalent in heart failure (HF) patients, yet these patients are poorly characterized. We aimed to describe the characteristics and outcomes of patients with systolic dysfunction and COPD in a contemporary HF randomized trial. Methods and Results: EVEREST investigated 4,133 patients hospitalized with worsening HF and an ejection fraction (EF) <= 40%. We analyzed the characteristics and outcomes (all-cause mortality and cardiovascular mortality/HF hospitalization) of patients according to baseline COPD status. COPD was present in 10% (n = 416) of patients. Patients with COPD had a higher prevalence of comorbidities and were less likely to receive a beta-blocker, angiotensin-converting enzyme inhibitor, or aldosterone antagonist. On univariate analysis, COPD was associated with increased all-cause mortality (HR 1.41, 95% CI 1.18-1.67) and cardiovascular mortality/HF hospitalization (HR 1.29, 95% CI 1.11-1.49). After adjusting for potential confounders, the risk associated with COPD remained increased, but was not statistically significant. Conclusion: The presence of COPD in HF patients is associated with an increased burden of comorbidities, lower use of HF therapies, and a trend toward worse outcomes. These findings provide a starting point for prospective investigations of the treatment of HF comorbidities to reduce the high postdischarge event rates. CI Cardiac Fail 2012;18:515-523)

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
COPD
heart failure
hospitalization
outcomes
beta-adrenoceptor agonists
quality-of-care
vasopressin antagonism
systolic dysfunction
tolvaptan everest
elderly-patients
optimize-hf
mortality
diagnosis
survival

Schmidt, P. H. (författare)
Kwasny, M. J. (författare)
Ambrosy, A. P. (författare)
O'Connor, C. M. (författare)
Konstam, M. A. (författare)
Zannad, F. (författare)
Maggioni, A. P. (författare)
Swedberg, Karl,1944Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine(Swepub:gu)xsweka (författare)
Gheorghiade, M. (författare)
Göteborgs universitetInstitutionen för medicin (creator_code:org_t)

Av författaren/redakt...: Mentz, R. J.; Schmidt, P. H.; Kwasny, M. J.; Ambrosy, A. P.; O'Connor, C. M.; Konstam, M. A.; visa fler...; Zannad, F.; Maggioni, A. P.; Swedberg, Karl, ...; Gheorghiade, M.; visa färre...

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