Prevalence, clinical and prognostic significance of chronic obstructive pulmonary disease in outpatients with heart failure: a subanalysis of the prospective multicenter registry study PRIORITY-HF

Aim. To assess the prevalence, clinical features and prognosis of heart failure (HF) combined with chronic obstructive pulmonary disease (COPD) according to the prospective observational multicenter registry study of Russian patients with HF — PRIORITY-HF.

Material and methods. The study included 19981 patients from 136 centers. Case report form was used to collect and analyze primary data. During the follow-up period, additional visits to the study centers were conducted at 6 and 12 months. Results. Overall prevalence of COPD in the examined cohort was 6,2%, while with HF with reduced (HFrEF), mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF) it was 7,5%/5,7%/5,4%, respectively (p<0,001). Patients with a combination of HF and COPD compared to the group without COPD were found to have a more severe course of HF as follows: a higher NYHA functional class, a longer duration of HF (24 months vs 23,6 months, p=0,001) and higher HF-related hospitalization rate in history (41,7% vs 31,4%, p<0,001). Comorbid conditions such as hypertension, coronary artery disease, atrial fibrillation, peripheral arterial disease, cerebrovascular disease, chronic kidney disease, and anemia were more frequently recorded in the group with concomitant COPD. Sodium-glucose cotransporter-2 inhibitors, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and quadruple therapy were used more frequently in the overall cohort with COPD compared to patients without COPD (p<0,001). The multivariate model demonstrated a more unfavorable prognosis for patients with concomitant COPD regarding all-cause mortality and hospitalizations (odds ratio (OR) 1,304, 95% confidence interval (CI) (1,046-1,625), p=0,018; OR 1,128, 95% CI (1,004-1,266), p=0,042).

Conclusion. A low incidence of COPD was found in the outpatient cohort of patients with HF, which may be associated with underdiagnosis in real-world practice. Patients with a combination of HF and COPD had a more severe course of HF, more often used the main classes of guideline-directed medical therapy and quadruple therapy, and a higher risk of all-cause mortality and hospitalizations during 12-month follow-up.

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