Heart Failure and COPD Exacerbation Risk

Pavankumar Kamat

Disclosures

May 10, 2021

Takeaway

  • 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).

Limitations

  • 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.

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