Griffo Raffaele, Spanevello Antonio, Temporelli Pier Luigi, Faggiano Pompilio, Carone Mauro, Magni Giovanna, Ambrosino Nicolino, Tavazzi Luigi
1 Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR), Research and Educational Centre, Italy.
2 Pulmonary Rehabilitation Unit, Salvatore Maugeri Foundation, IRCCS, Tradate and University of Insubria, Italy.
Eur J Prev Cardiol. 2017 Apr;24(6):567-576. doi: 10.1177/2047487316687425. Epub 2017 Jan 9.
Background Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) frequently coexist but concurrent COPD + CHF has been little investigated. Design This multicentre survey (SUSPIRIUM) was designed to evaluate: the prevalence of COPD in stable CHF and CHF in stable COPD; diagnostic/therapeutic work-up for concurrent COPD + CHF; clinical profile of patients with COPD + CHF; predictors of COPD in CHF and CHF in COPD. Methods A 5-month-long cross-sectional prospective observational survey was conducted in 10 cardiac and 10 respiratory connected outpatient units. Results The prevalence of CHF in the 378 surveyed COPD patients was 11.9% (95% confidence interval 8.8-16.6) and the prevalence of COPD in 375 CHF patients was 31.5% (95% confidence interval 26.8-36.4). Diagnostic tests for suspected comorbidity were prescribed in 21.6% and 22.9% of COPD and CHF patients, respectively. Patients with coexisting CHF + COPD had a higher incidence of hypertension, physical inactivity and more frequently a GOLD score of 3 or greater. Compared to CHF only, CHF + COPD patients were significantly older, more frequently smokers, at worse respiratory risk and in a higher New York Heart Association class. Conversely, hypercholesterolaemia, a family history of ischaemic heart disease, fluid retention and comorbidities were more frequent in COPD + CHF than COPD-only patients. At multivariate analysis, a GOLD score of 3 or greater in CHF strongly predicted coexistent COPD (odds ratio 8.985, P < 0.0001) as did a history of other respiratory diseases (5.184, P < 0.0001). A history of ischaemic heart disease (4.868, P < 0.0001), atrial fibrillation (3.302, P < 0.0001) and sedentary lifestyle (2.814, P < 0.004) predicted coexistent CHF in COPD. Conclusion The high prevalence of COPD + CHF calls for integrated disease management between cardiologists and pulmonologists. SUSPIRIUM identifies which cardiac/pulmonary outpatients should be screened for the respective comorbidity.
背景 慢性心力衰竭（CHF）与慢性阻塞性肺疾病（COPD）常并存，但COPD合并CHF的情况鲜少被研究。设计 这项多中心调查（SUSPIRIUM）旨在评估：稳定型CHF患者中COPD的患病率以及稳定型COPD患者中CHF的患病率；COPD合并CHF的诊断/治疗评估；COPD合并CHF患者的临床特征；CHF患者中COPD的预测因素以及COPD患者中CHF的预测因素。方法 在10个心脏科和10个呼吸科相关门诊单元进行了为期5个月的横断面前瞻性观察性调查。结果 在378例接受调查的COPD患者中，CHF的患病率为11.9%（95%置信区间8.8 - 16.6），在375例CHF患者中，COPD的患病率为31.5%（95%置信区间26.8 - 36.4）。分别有21.6%的COPD患者和22.9%的CHF患者接受了疑似合并症的诊断检查。CHF合并COPD患者高血压、身体活动少的发生率更高，且GOLD分级为3级或更高的情况更常见。与单纯CHF患者相比，CHF合并COPD患者年龄更大、吸烟者更多、呼吸风险更差且纽约心脏协会分级更高。相反，COPD合并CHF患者的高胆固醇血症、缺血性心脏病家族史、液体潴留和合并症比单纯COPD患者更常见。多因素分析显示，CHF患者中GOLD分级为3级或更高强烈预测并存COPD（比值比8.985，P < 0.0001），其他呼吸系统疾病史也有同样作用（5.184，P < 0.0001）。缺血性心脏病史（4.868，P < 0.0001）、心房颤动（3.302，P < 0.0001）和久坐生活方式（2.814，P < 0.004）预测COPD患者中并存CHF。结论 COPD合并CHF的高患病率需要心脏病专家和肺病专家进行综合疾病管理。SUSPIRIUM确定了哪些心脏科/呼吸科门诊患者应接受各自合并症的筛查。
