For patients with comorbid heart failure (HF) and chronic obstructive pulmonary disease (COPD), risk for hospitalization and death were highest among patients with HF with reduced ejection fraction (HFrEF), according to a study published in the Annals of the American Thoracic Society.
Researchers sourced data from the OptumLabsÒ Data Warehouse, which includes administrative claims and electronic health records of commercially insured and Medicare Advantage patients living in the United States. Patients (N=5419) with COPD and an incident HF diagnosis between 2008 and 2018 were assessed for outcomes and healthcare resource use.
The study population had a median age of 74 (IQR, 67-80) years; 50.1% were men; 97.3% had hypertension; 79.3% coronary artery disease; 49.3% atrial fibrillation; 49.0% cerebrovascular disease; and 17.7% were never smokers.
Patients had HF with preserved ejection fraction (HFpEF; 70%), HFrEF (20%), and HF with mildly reduced ejection fraction (HFmrEF; 10%). Patients with HFpEF had a higher prevalence of comorbidities.
Half of patients (50.5%) were admitted to the hospital within 1 year of their HF diagnosis. The most frequent outcome during hospitalization was acute exacerbation of COPD (AECOPD), occurring among 38% of the HFpEF, 29.9% HFmrEF, and 29.4% HFrEF groups (P <.001).
Stratified by AECOPD severity, more patients with HFpEF had severe AECOPD compared with HFmrEF or HFrEF (11.6% vs 9.3% vs 7.2%; P <.001), respectively. Compared with HFpEF, risk for admission to the hospital for AECOPD was decreased among the HFrEF (adjusted hazard ratio [aHR], 0.75; 95% CI, 0.65-0.97; P <.001) and HFmrEF (aHR, 0.82; 95% CI, 0.69-0.97; P =.024) cohorts.
More patients with HFrEF were admitted to the hospital for HF (20.0%) compared with HFpEF (15.5%) or HFmrEF (15.8%; P <.01). Risk for HF hospitalization was increased for HFrEF (aHR, 1.54; 95% CI, 1.29-1.84; P <.001).
Mortality occurred among 39.2% of the HFrEF, 33.8% of the HFmrEF, and 37.7% of the HFpEF cohorts. In the fully adjusted model, mortality risk was increased among patients with HFpEF (aHR, 1.16; 95% CI, 1.03-1.32).
Outpatient healthcare resource use was highest among HFrEF (median, $3510; IQR, $1100-$8960) compared with HFpEF (median, $2900; IQR, $900-$7490) and HFmrEF (median, $2550; IQR, $857-$6560; P <.01) groups. Overall healthcare costs did not differ significantly between cohorts (P =.06).
The study may have been limited by subdividing patients on the basis of left ventricular ejection fraction, as the accuracy of the measurements can vary across technology used.
Researchers concluded that patients with COPD and HF comorbidities who had HFrEF were at increased risk for hospitalization and death. Overall, the greatest healthcare burden was due to AECOPD, especially among patients with HFpEF.
“While improvements have been observed with emerging therapies such as SGLT2is and sacubitril/valsartan for subgroups of patients with HFpEF, management strategies to treat the significant multi-morbidity burden in these patients are still needed,” the study authors said. “A more comprehensive primary care assessment to differentiate between cardiac and respiratory symptoms with greater precision and emphasis on the recognition and management of COPD may provide an opportunity to reduce AECOPD and improve outcomes for these patients.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Gulea C, Zakeri R, Quint JK. Differences in outcomes between heart failure phenotypes in patients with coexistent COPD: a cohort study. Ann Am Thorac Soc. Published online December 14, 2021. doi:10.1513/AnnalsATS.202107-823OC