Heart Failure and COPD Exacerbation Risk

Pavankumar Kamat


May 10, 2021


  • Newly diagnosed heart failure (HF) and possible HF were associated with a similar increased risk of chronic obstructive pulmonary disease (COPD) exacerbation.

  • Both incident and prevalent use of all HF medications were associated with a higher risk of exacerbation compared with non-use.

  • The prevalent use of all HF medications was associated with a lower risk of exacerbation compared with incident use.

Why this matters

  • Findings suggest that early diagnosis and optimal management of HF in primary care patients with COPD may reduce the risk of exacerbation.

Study design

  • A retrospective cohort study included 86,795 patients with COPD (60,047 without HF, 8476 with possible HF, 2066 with newly diagnosed HF) from the UK Clinical Practice Research Datalink.

  • Associations of incident use (<6 months of continuous exposure) and prevalent use (≥6 months of continuous exposure) of HF medications with COPD exacerbation were determined.

  • Funding: NIHR Imperial Biomedical Research Centre.

Key results

  • Newly diagnosed HF (adjusted HR [aHR], 1.45; 95% CI, 1.30-1.62) and possible HF (aHR, 1.65; 95% CI, 1.58-1.72) were associated with a similar increased risk of COPD exacerbation.

  • The risk of exacerbation increased with:

    • incident use of (aHR; 95% CI):

      • angiotensin-converting enzyme inhibitor (ACEi; 5.38; 4.79-6.05);

      • angiotensin receptor blocker (ARB; 5.99; 5.08-7.07);

      • beta-blocker (BB; 5.65; 4.92-6.49);

      • loop diuretics (LD; 4.76; 4.31-5.25); and

      • mineralocorticoid receptor antagonist (MRA; 6.01; 5.31-6.80).

    • prevalent use of (aHR; 95% CI):

      • ACEi (1.11; 1.03-1.19);

      • ARB (1.22; 1.12-1.32);

      • BB (1.41; 1.32-1.51);

      • LD (1.12; 1.05-1.20); and

      • MRA (1.61; 1.48-1.74).

  • The risk of exacerbation decreased with the prevalent vs incident use of (aHR; 95% CI):

    • ACEi (0.24; 0.22-0.27);

    • ARB (0.23; 0.20-0.26);

    • BB (0.27; 0.25-0.30);

    • LD (0.25; 0.23-0.27); and

    • MRA (0.32; 0.28-0.35).


  • Retrospective design.


Axson EL, Bottle A, Cowie MR, Quint JK. Relationship between heart failure and the risk of acute exacerbation of COPD. Thorax. 2021 Apr 29 [Epub ahead of print]. doi: 10.1136/thoraxjnl-2020-216390. PMID: 33927022.  View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.