Correlation between chronic obstructive pulmonary disease and heart failure with reduced ejection fraction: is it just a comorbidity?

Abstract Introduction Heart failure (HF) is a complex clinical syndrome that frequently coexists with other comorbidities, such as chronic obstructive pulmonary disease (COPD). The presence of COPD in patients with HF with reduced ejection fraction (HFrEF) may negatively impact disease progression and prognosis. Purpose To compare the baseline clinical characteristics and the medium- to long-term prognosis of patients with HFrEF and COPD to those with HFrEF without COPD. Methods We conducted a retrospective study including all patients assessed in our hospital between 2018 and 2020 who had HF and a reduced ejection fraction (≤40%). Patients diagnosed with COPD (group 1) were compared to those without COPD (group 2). Clinical, analytical, echocardiographic, and therapeutic variables were analysed, as well as an assessment of medium- to long-term outcomes in terms of mortality and readmissions for HF. Results A total of 375 patients were analysed, of whom 71 belonged to the COPD group and the remaining 304 patients were included in the non-COPD group. Group 1 had a significantly higher mean age (70.8±9.2 vs. 65.9±13.2, p 0.001). A higher prevalence of former smokers was observed in group 1 (64.8% vs. 35.5%, p 0.001), with no differences in other comorbidities. The rate of de novo HF was significantly higher in group 2 (42.2% vs. 56.3%, p=0.033), with a higher rate of left ventricular ejection fraction (LVEF) improvement (30.9% vs. 44.1%, p=0.044). For both groups, the most common aetiology was ischemic heart disease. No differences were observed in LVEF between the groups, but group 1 had significantly lower left ventricular end-systolic volumes (104.7±35.6 vs. 118.2±50.3, p=0.028), a lower tricuspid annular plane systolic excursion (18.7±4.5 vs. 16.5±6.1, p=0.047), and a higher pulmonary artery systolic pressure (27.6±9.1 vs. 31.8±10.6, p=0.018). No differences in neurohormonal medication were found but a higher prescription of angiotensin receptor-neprilysin inhibitors in group 1 (46.5% vs. 32.2%, p=0.023). As shown in the Kaplan-Meier curves, with a median follow-up of 40 months, group 1 had a higher readmissions rate for HF (50.7% vs. 35.2%, log-rank test: p=0.014) and significantly higher HF mortality (33.8% vs 18.4%, log-rank test: p=0.006) compared to group 2. Conclusions The coexistence of COPD and HFrEF represents a common clinical condition with relevant prognostic implications. Our findings suggest that the presence of COPD in patients with HFrEF is associated with a significantly increased risk of readmissions for HF and HF mortality, underscoring the need for a comprehensive and multidisciplinary therapeutic approach in this population.Baseline clinical characteristics Kaplan-Meier survival analysis