Study Finds Differences in Patients With Both COPD, Heart Failure

Patients with both heart failure (HF) and chronic obstructive pulmonary disease (COPD) face a unique set of challenges and impairment compared with those with just one of the diseases, according to a new report.

The study, published in Scientific Reports, offers new insights to help physicians better treat patients with overlapping conditions.

Corresponding author Audrey Borghi-Silva, PhD, MSc, of the Federal University of São Carlos in Brazil, and colleagues said cardiopulmonary disease has grown in prevalence in recent decades, to the point where it is the cause of death for approximately 1 in 5 Brazilians over the age of 30.

It has already been reported that patients with both heart failure and COPD experience a lower quality of life and increased health care utilization. In the new report, Borghi-Silva and colleagues sought to determine the prevalence of the diseases’ co-existence and assess its impact on cardiorespiratory exercise and fitness.

The investigators screened more than 300 patients who were between the ages of 40 and 85 who had been diagnosed with heart failure with reduced ejection fraction and/or COPD. To be included in the final study, all of the patients were required to have disease that was considered stable, no recent hospitalizations, and no other conditions that might limit exercise capacity.

A total of 124 patients were included in the final analysis, of whom 46 had heart failure, 53 had COPD, and 25 had both. The patients underwent advanced pulmonary function tests, echocardiography, body composition analysis assessments, and symptom-limited incremental cardiopulmonary exercise testing using a cycle ergometer. Following the exercise test, patients were contacted by phone every 6 months for the next 2 years. On the phone calls, investigators asked about exacerbations and hospitalizations, and also to verify that patients were still living.

The analysis led to several findings. First, the authors found that the prevalence of concomitant heart failure and COPD was about 1 in 5 in their cohort, which was in line with earlier research.

In terms of cardiac function, patients with heart failure, with or without COPD, had systolic dysfunction, and at similar levels, while patients with just COPD had preserved ejection fraction (heart failure alone: mean [SD] 40 [ 7]; COPD alone: 70 [8]; heart failure plus COPD: 38 [8]).

Likewise, patients with COPD had evidence of an obstructive ventilatory disorder as confirmed by forced expiratory volume percentage (FEV₁). Patients with heart failure alone had FEV₁ readings of 84 [20], while those with COPD alone or COPD plus heart failure had readings of 54 [21] and 65 [25], respectively.

Patients with both heart failure and COPD had a lower work rate, peak oxygen uptake, rate pressure product, and circulatory and ventilatory power, compared with patients with one condition or the other.

In terms of outcomes, the authors said there was no significant difference in the occurrence of events and deaths between groups.

“The coexistence of HF + COPD induces greater impairment on exercise performance when compared to patients without overlapping diseases, however the overlap of the 2 diseases did not increase the probability of the occurrence of cardiopulmonary events and deaths when compared to groups with isolated diseases in the period studied,” Borghi-Silva and colleagues said.

The authors said the cardiopulmonary exercise testing appeared to be an important tool to help monitor patients and track progress in exercise performance and functional capacity.

Reference:

Dos Santos PB, Simões RP, Goulart CL, et al. Responses to incremental exercise and the impact of the coexistence of HF and COPD on exercise capacity: a follow-up study. Sci Rep. Published online January 31, 2022. doi:10.1038/s41598-022-05503-5