Abstract 13323: Chronic Obstructive Pulmonary Disease is Associated with Adverse Events in Patients Hospitalized for Heart Failure with Reduced Ejection Fraction: An Analysis of the EVEREST Trial
Introduction: Studies examining the prognostic implications of chronic obstructive pulmonary disease (COPD) in patients hospitalized for heart failure (HF) have reached conflicting conclusions.
Hypothesis: COPD is associated with increased short- and long-term morbidity and mortality in patients hospitalized for HF with reduced ejection fraction (EF).
Methods: A post-hoc analysis of The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, which randomized 4133 patients hospitalized for worsening HF and an EF <40% within 48 hours of admission to placebo or tolvaptan, in addition to standard therapy, for a median follow-up of 9.9 months. Outcomes included all-cause mortality (ACM), cardiovascular (CV) death or HF hospitalization, and clinically worsening HF. Times to events were compared using log-rank tests and multivariate Cox regression models.
Results: A total of 416 patients (10%) had a history of COPD. Patients with COPD were older (69.6+10.0 years vs. 65.3+12.0 years), more likely to be smokers (21.4% vs. 11.4%) or ex-smokers (64.2% vs. 51.9%), and more likely to have coronary artery disease (77.9% vs. 69.7%) and chronic kidney disease (42.9% vs. 25.0%). COPD patients had a higher rate of ACM (35.8% vs. 25.1%), CV death or HF hospitalization (55.1% vs. 46.7%), and clinically worsening HF (42.8% vs. 35.5%). Unadjusted analysis showed that COPD patients had a significantly shorter time to all three outcomes (Figure). After adjusting for baseline covariates, COPD remained a marginally significant predictor of time to CV death or HF hospitalization (Hazard ratio [HR] = 1.19; 95% confidence interval [CI] 1.01-1.39) but not ACM or clinically worsening HF.
Conclusion: While COPD is associated with major adverse CV outcomes after hospitalization for HF with reduced EF, this association is attenuated after adjusting for confounders. Addressing comorbidities is important to reducing post-discharge events.
- © 2011 by American Heart Association, Inc.