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 journalArticlepeer-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 languageEnglish (US)
Pages (from-to)515-523
Number of pages9
JournalJournal of Cardiac Failure
Volume18
Issue number7
DOIs
StatePublished - 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

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