Becher Peter Moritz, Lindberg Felix, Benson Lina, Hage Camilla, Dahlström Ulf, Rosenkranz Stephan, Cosentino Francesco, Rosano Giuseppe M C, Blankenberg Stefan, Kirchhof Paulus, Braunschweig Frieder, Lund Lars H, Savarese Gianluigi
Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
ESC Heart Fail. 2025 Apr;12(2):900-911. doi: 10.1002/ehf2.15127. Epub 2024 Nov 7.
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are prevalent comorbidities associated with significant morbidity/mortality. We assessed prevalence of, patient profiles and outcomes associated with COPD across the ejection fraction (EF) spectrum.
HF patients enrolled in the Swedish HF registry between 2005 and 2021 were considered. Multivariable logistic regression models were fitted to assess patient characteristics independently associated with COPD and Cox regression models for investigating the associations between COPD and outcomes, that is, morbidity/mortality.
Among 97 904 HF patients, COPD prevalence was 13%, highest in HF with preserved EF [HFpEF: 16%, HF with mildly reduced EF (HFmrEF): 12%, HF with reduced EF (HFrEF): 11%]. Key patient characteristics independently associated with a diagnosis of COPD included higher EF, female sex, smoking, obstructive sleep disorder, peripheral artery disease, a lower educational level, more severe HF, more likely mineralocorticoid receptor antagonist and diuretic use but less likely use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin-receptor-neprilysin inhibitors (not in HFrEF), beta-blockers, HF device therapies, and follow-up in HF nurse-led clinics. COPD was independently associated with a 15% higher risk of cardiovascular (CV) death/HF hospitalization [hazard ratio: 1.15 (95% confidence interval: 1.11-1.18)], CV death, non-CV death, all-cause death and HF hospitalizations, regardless of EF.
COPD was present in every eight patient with HF, and more common with preserved EF. Patients with COPD had more severe HF, heavier comorbidity burden and worse morbidity/mortality regardless of EF. Our results call for improved diagnostic and management strategies in patients with HF and COPD.
慢性阻塞性肺疾病（COPD）和心力衰竭（HF）是常见的共病，与显著的发病率/死亡率相关。我们评估了射血分数（EF）范围内COPD的患病率、患者特征及相关结局。
纳入2005年至2021年瑞典心力衰竭登记处登记的HF患者。采用多变量逻辑回归模型评估与COPD独立相关的患者特征，并采用Cox回归模型研究COPD与结局（即发病率/死亡率）之间的关联。
在97904例HF患者中，COPD患病率为13%，在射血分数保留的心力衰竭（HFpEF）中最高[HFpEF：16%，射血分数轻度降低的心力衰竭（HFmrEF）：12%，射血分数降低的心力衰竭（HFrEF）：11%]。与COPD诊断独立相关的关键患者特征包括较高的EF、女性、吸烟、阻塞性睡眠障碍、外周动脉疾病、较低的教育水平、更严重的HF、更可能使用盐皮质激素受体拮抗剂和利尿剂，但不太可能使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂（HFrEF中不适用）、β受体阻滞剂、HF器械治疗以及在HF护士主导的诊所进行随访。无论EF如何，COPD均与心血管（CV）死亡/HF住院风险高15%独立相关[风险比：1.15（95%置信区间：1.11 - 1.18）]，包括CV死亡、非CV死亡、全因死亡和HF住院。
每八例HF患者中就有一例患有COPD，在射血分数保留的患者中更为常见。无论EF如何，COPD患者的HF更严重，合并症负担更重，发病率/死亡率更差。我们的结果呼吁改善HF和COPD患者的诊断和管理策略。
