Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
J Card Fail. 2012 Jul;18(7):515-23. doi: 10.1016/j.cardfail.2012.04.010. Epub 2012 Jun 4.
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.
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.
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.
慢性阻塞性肺疾病（COPD）在心力衰竭（HF）患者中较为普遍，但这些患者的特征描述不足。我们旨在描述在当代 HF 随机试验中收缩功能障碍和 COPD 患者的特征和结局。
EVEREST 研究了 4133 名因 HF 恶化且射血分数（EF）≤40%住院的患者。我们根据基线 COPD 状况分析了患者的特征和结局（全因死亡率和心血管死亡率/ HF 再住院率）。10%（n=416）的患者存在 COPD。COPD 患者合并症的患病率更高，β受体阻滞剂、血管紧张素转换酶抑制剂或醛固酮拮抗剂的使用率较低。在单变量分析中，COPD 与全因死亡率（HR 1.41，95%CI 1.18-1.67）和心血管死亡率/ HF 再住院率（HR 1.29，95%CI 1.11-1.49）增加相关。在调整潜在混杂因素后，COPD 相关风险仍然增加，但无统计学意义。
HF 患者存在 COPD 与合并症负担增加、HF 治疗使用率降低以及结局恶化趋势相关。这些发现为前瞻性研究 HF 合并症的治疗以降低高出院后事件发生率提供了起点。
