Department of Cardiovascular Medicine, Nippon Medical School, Bunkyō, Tokyo, Japan.
National Heart Centre Singapore, Singapore, Singapore.
ESC Heart Fail. 2018 Apr;5(2):297-305. doi: 10.1002/ehf2.12228. Epub 2017 Oct 21.
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are increasingly frequent in Asia and commonly coexist in patients. However, the prevalence of COPD among Asian patients with HF and its impact on HF treatment are unclear.
We compared clinical characteristics and treatment approaches between patients with or without a history of COPD, before and after 1:2 propensity matching (for age, sex, geographical region, income level, and ethnic group) in 5232 prospectively recruited patients with HF and reduced ejection fraction (HFrEF, <40%) from 11 Asian regions (Northeast Asia: South Korea, Japan, Taiwan, Hong Kong, and China; South Asia: India; Southeast Asia: Thailand, Malaysia, Philippines, Indonesia, and Singapore). Among the 5232 patients with HFrEF, a history of COPD was present in 8.3% (n = 434), with significant variation in geography (11.0% in Northeast Asia vs. 4.7% in South Asia), regional income level (9.7% in high income vs. 5.8% in low income), and ethnicity (17.0% in Filipinos vs. 5.2% in Indians) (all P < 0.05). Use of mineralocorticoid receptor antagonists and diuretics was similar between groups, while usage of all β-blockers was lower in the COPD group than in the non-COPD group in the overall (66.3% vs. 79.9%) and propensity-matched cohorts (66.3% vs. 81.7%) (all P < 0.05). A striking exception was the Japanese cohort in which β-blocker use was high in COPD and non-COPD patients (95.2% vs. 91.2%).
The prevalence of COPD in HFrEF varied across Asia and was related to underuse of β-blockers, except in Japan.
慢性阻塞性肺疾病（COPD）和心力衰竭（HF）在亚洲越来越常见，并且常同时存在于患者中。然而，亚洲 HF 患者中 COPD 的患病率及其对 HF 治疗的影响尚不清楚。
我们比较了来自 11 个亚洲地区（东北亚：韩国、日本、中国台湾、中国香港和中国大陆；南亚：印度；东南亚：泰国、马来西亚、菲律宾、印度尼西亚和新加坡）的 5232 例接受 HF 并射血分数降低（HFrEF，<40%）前瞻性治疗的患者中，有或无 COPD 病史患者的临床特征和治疗方法。在这 5232 例 HFrEF 患者中，有 COPD 病史的患者占 8.3%（n=434），地理分布（东北亚 11.0%，南亚 4.7%）、区域收入水平（高收入 9.7%，低收入 5.8%）和种族（菲律宾人 17.0%，印度人 5.2%）存在显著差异（均 P<0.05）。两组患者使用盐皮质激素受体拮抗剂和利尿剂的情况相似，而在整体队列（66.3%比 79.9%）和倾向匹配队列（66.3%比 81.7%）中，COPD 组比非 COPD 组β受体阻滞剂的使用率均较低（均 P<0.05）。一个显著的例外是日本队列，其中 COPD 和非 COPD 患者的β受体阻滞剂使用率均较高（95.2%比 91.2%）。
亚洲 HF 患者中 COPD 的患病率存在差异，与β受体阻滞剂的使用率较低有关，但日本除外。
