Clinical Characteristics and Prognosis of Acute Heart Failure in Patients with Chronic Obstructive Pulmonary Disease

Abstract

This study describes clinical profiles of acute heart failure (AHF) patients from the Heart Failure Registry of Patient Outcomes (HERO) study and evaluates the prognostic impact of chronic obstructive pulmonary disease (COPD). HERO enrolled 5,620 hospitalized AHF patients (November 2017 to 2018); 4,428 were followed. Primary endpoint: composite all-cause death or heart failure (HF) readmission. Secondary endpoints included all-cause death, HF readmission, and cardiovascular death. Patients were stratified by COPD status. Clinical characteristics were compared. Adjusted multivariate Cox regression estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for COPD's impact on outcomes. Kaplan-Meier analysis (log-rank test) compared time-to-event data; sensitivity analyses were performed. Of 4,428 patients, 405 (9.2%) had COPD. COPD patients were older, more often male, had lower education, higher smoking rates, and received care predominantly in secondary hospitals. They had lower body mass index (BMI), higher heart rate, elevated hemoglobin (Hb), higher New York Heart Association (NYHA) class IV prevalence, but lower N-terminal pro–B-type natriuretic peptide (NT-proBNP). Hypertension, diabetes, and coronary artery disease were less frequent; hyponatremia was more common. Use of renin-angiotensin-aldosterone system (RAAS) inhibitors, β-blockers, statins, and diuretics was significantly lower in the COPD group. After adjustment, COPD independently predicted higher risks for the composite endpoint (HR = 1.38, 95% CI: 1.17 to 1.62, p <0.001), HF readmission (HR = 1.26, 95% CI: 1.02 to 1.55, p = 0.047), cardiovascular death (HR = 1.38, 95% CI: 1.09 to 1.74, p = 0.008), and all-cause death (HR = 1.40, 95% CI: 1.15 to 1.72, p = 0.001). Survival curves showed early and widening separation, indicating worse COPD outcomes. COPD independently increases adverse outcome risk in AHF patients. These individuals often present with poorer baseline health, leading to unfavorable prognosis. Integrated multidisciplinary care and individualized treatment are crucial to improve survival.