The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: An analysis of the EVEREST trial

Robert J. Mentz; Philip H. Schmidt; Mary J. Kwasny; Andrew P. Ambrosy; Christopher M. O'Connor; Marvin A. Konstam; Faiez Zannad; Aldo P. Maggioni; Karl Swedberg; Mihai Gheorghiade

doi:10.1016/j.cardfail.2012.04.010

The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: An analysis of the EVEREST trial

Robert J. Mentz, Philip H. Schmidt, Mary J. Kwasny, Andrew P. Ambrosy, Christopher M. O'Connor, Marvin A. Konstam, Faiez Zannad, Aldo P. Maggioni, Karl Swedberg, Mihai Gheorghiade^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

57 Scopus citations

Abstract

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 β-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.

Original language	English (US)
Pages (from-to)	515-523
Number of pages	9
Journal	Journal of Cardiac Failure
Volume	18
Issue number	7
DOIs	https://doi.org/10.1016/j.cardfail.2012.04.010
State	Published - Jul 2012

Funding

Otsuka Inc. (Rockville, Maryland) provided financial and material support for the EVEREST trial. Dr Konstam receives research grants from and is a consultant for Otsuka , Johnson & Johnson , Amgen , and Trevena . Dr O'Connor is a consultant for Merck & Co., Inc., Trevena, Novella, Pfizer Inc., GE Healthcare, Roche, Amgen, Martek, Actelion, and JNJ. Dr Zannad has received honoraria from and served on advisory boards for Pfizer Inc. Dr Maggioni receives honoraria from Otsuka. Dr Swedberg receives research grants from AstraZeneca , Servier , and Amgen ; honoraria from AstraZeneca, Otsuka, Servier, and Amgen; and is a consultant for Cytokinetics, Servier, and Novartis. Dr Gheorghiade is a consultant for Abbott Labs, Astellas, AstraZeneca, Bayer Schering Pharma AG, CorThera Inc., Cytokinetics Inc., DebioPharm S.A., Errekappa Terapeutici (Milan, Italy), Glaxo Smith Kline, Johnson & Johnson, Medtronic, Novartis Pharma AG, Otsuka, Sigma Tau, Solvay Pharmaceuticals, and Pericor Therapeutics. The other authors declare no conflict of interest.

Keywords

COPD
heart failure
hospitalization
outcomes

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.cardfail.2012.04.010

Cite this

Mentz, R. J., Schmidt, P. H., Kwasny, M. J., Ambrosy, A. P., O'Connor, C. M., Konstam, M. A., Zannad, F., Maggioni, A. P., Swedberg, K., & Gheorghiade, M. (2012). The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: An analysis of the EVEREST trial. Journal of Cardiac Failure, 18(7), 515-523. https://doi.org/10.1016/j.cardfail.2012.04.010

@article{cb02d08a78814daab25f65e134dc00bc,

title = "The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: An analysis of the EVEREST trial",

abstract = "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 β-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.",

keywords = "COPD, heart failure, hospitalization, outcomes",

author = "Mentz, {Robert J.} and Schmidt, {Philip H.} and Kwasny, {Mary J.} and Ambrosy, {Andrew P.} and O'Connor, {Christopher M.} and Konstam, {Marvin A.} and Faiez Zannad and Maggioni, {Aldo P.} and Karl Swedberg and Mihai Gheorghiade",

note = "Funding Information: Otsuka Inc. (Rockville, Maryland) provided financial and material support for the EVEREST trial. Dr Konstam receives research grants from and is a consultant for Otsuka , Johnson & Johnson , Amgen , and Trevena . Dr O'Connor is a consultant for Merck & Co., Inc., Trevena, Novella, Pfizer Inc., GE Healthcare, Roche, Amgen, Martek, Actelion, and JNJ. Dr Zannad has received honoraria from and served on advisory boards for Pfizer Inc. Dr Maggioni receives honoraria from Otsuka. Dr Swedberg receives research grants from AstraZeneca , Servier , and Amgen ; honoraria from AstraZeneca, Otsuka, Servier, and Amgen; and is a consultant for Cytokinetics, Servier, and Novartis. Dr Gheorghiade is a consultant for Abbott Labs, Astellas, AstraZeneca, Bayer Schering Pharma AG, CorThera Inc., Cytokinetics Inc., DebioPharm S.A., Errekappa Terapeutici (Milan, Italy), Glaxo Smith Kline, Johnson & Johnson, Medtronic, Novartis Pharma AG, Otsuka, Sigma Tau, Solvay Pharmaceuticals, and Pericor Therapeutics. The other authors declare no conflict of interest.",

year = "2012",

month = jul,

doi = "10.1016/j.cardfail.2012.04.010",

language = "English (US)",

volume = "18",

pages = "515--523",

journal = "Journal of Cardiac Failure",

issn = "1071-9164",

publisher = "Elsevier B.V.",

number = "7",

}

Mentz, RJ, Schmidt, PH, Kwasny, MJ, Ambrosy, AP, O'Connor, CM, Konstam, MA, Zannad, F, Maggioni, AP, Swedberg, K & Gheorghiade, M 2012, 'The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: An analysis of the EVEREST trial', Journal of Cardiac Failure, vol. 18, no. 7, pp. 515-523. https://doi.org/10.1016/j.cardfail.2012.04.010

The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: An analysis of the EVEREST trial. / Mentz, Robert J.; Schmidt, Philip H.; Kwasny, Mary J. et al.
In: Journal of Cardiac Failure, Vol. 18, No. 7, 07.2012, p. 515-523.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction

T2 - An analysis of the EVEREST trial

AU - Mentz, Robert J.

AU - Schmidt, Philip H.

AU - Kwasny, Mary J.

AU - Ambrosy, Andrew P.

AU - O'Connor, Christopher M.

AU - Konstam, Marvin A.

AU - Zannad, Faiez

AU - Maggioni, Aldo P.

AU - Swedberg, Karl

AU - Gheorghiade, Mihai

N1 - Funding Information: Otsuka Inc. (Rockville, Maryland) provided financial and material support for the EVEREST trial. Dr Konstam receives research grants from and is a consultant for Otsuka , Johnson & Johnson , Amgen , and Trevena . Dr O'Connor is a consultant for Merck & Co., Inc., Trevena, Novella, Pfizer Inc., GE Healthcare, Roche, Amgen, Martek, Actelion, and JNJ. Dr Zannad has received honoraria from and served on advisory boards for Pfizer Inc. Dr Maggioni receives honoraria from Otsuka. Dr Swedberg receives research grants from AstraZeneca , Servier , and Amgen ; honoraria from AstraZeneca, Otsuka, Servier, and Amgen; and is a consultant for Cytokinetics, Servier, and Novartis. Dr Gheorghiade is a consultant for Abbott Labs, Astellas, AstraZeneca, Bayer Schering Pharma AG, CorThera Inc., Cytokinetics Inc., DebioPharm S.A., Errekappa Terapeutici (Milan, Italy), Glaxo Smith Kline, Johnson & Johnson, Medtronic, Novartis Pharma AG, Otsuka, Sigma Tau, Solvay Pharmaceuticals, and Pericor Therapeutics. The other authors declare no conflict of interest.

PY - 2012/7

Y1 - 2012/7

N2 - 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 β-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.

AB - 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 β-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.

KW - COPD

KW - heart failure

KW - hospitalization

KW - outcomes

UR - http://www.scopus.com/inward/record.url?scp=84862994170&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862994170&partnerID=8YFLogxK

U2 - 10.1016/j.cardfail.2012.04.010

DO - 10.1016/j.cardfail.2012.04.010

M3 - Article

C2 - 22748484

AN - SCOPUS:84862994170

SN - 1071-9164

VL - 18

SP - 515

EP - 523

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

IS - 7

ER -

The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: An analysis of the EVEREST trial

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this