Impact of chronic obstructive pulmonary disease in patients with heart failure with preserved ejection fraction: insights from PARAGON‐HF

Mooney, L. et al. (2021) Impact of chronic obstructive pulmonary disease in patients with heart failure with preserved ejection fraction: insights from PARAGON‐HF. Journal of the American Heart Association, 10(23), e021494. (doi: 10.1161/JAHA.121.021494) (PMID:34796742)

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Abstract

Background: Little is known about the impact of chronic obstructive pulmonary disease (COPD) in patients with heart failure with preserved ejection fraction (HFpEF). Methods and Results: We examined outcomes in patients with heart failure with preserved ejection fraction, according to COPD status, in the PARAGON‐HF (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. The primary outcome was a composite of first and recurrent hospitalizations for heart failure and cardiovascular death. Of 4791 patients, 670 (14%) had COPD. Patients with COPD were more likely to be men (58% versus 47%; P<0.001) and had worse New York Heart Association functional class (class III/IV 24% versus 19%), worse Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores (69 versus 76; P<0.001) and more frequent history of heart failure hospitalization (54% versus 47%; P<0.001). The decrement in Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores with COPD was greater than for other common comorbidities. Patients with COPD had echocardiographic right ventricular enlargement, higher serum creatinine (100 μmol/L versus 96 μmol/L) and neutrophil‐to‐lymphocyte ratio (2.7 versus 2.5), than those without COPD. After multivariable adjustment, COPD was associated with worse outcomes: adjusted rate ratio for the primary outcome 1.51 (95% CI, 1.25–1.83), total heart failure hospitalization 1.54 (95% CI, 1.24–1.90), cardiovascular death (adjusted hazard ratio [HR], 1.42; 95% CI, 1.10–1.82), and all‐cause death (adjusted HR, 1.52; 95% CI, 1.25–1.84). COPD was associated with worse outcomes than other comorbidities and Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores declined more in patients with COPD than in those without. Conclusions: Approximately 1 in 7 patients with heart failure with preserved ejection fraction had concomitant COPD, which was associated with greater functional limitation and a higher risk of heart failure hospitalization and death.

Item Type:Articles
Additional Information:PARAGON-HF was funded by Novartis. Dr McMurray is supported by a British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Jhund, Dr Pardeep and Mooney, Dr Leanne and McMurray, Professor John
Authors: Mooney, L., Hawkins, N. M., Jhund, P. S., Redfield, M. M., Muthiah Vaduganathan, M., Desai, A. S., Rouleau, J. L., Minamisawa, M., Shah, A. M., Lefkowitz, M. P., Zile, M. R., Van Veldhuisen, D. J., Pfeffer, M. A., Anand, I. S., Maggioni, A. P., Senni, M., Claggett, B. L., Solomon, S. D., and McMurray, J. J. V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Journal of the American Heart Association
Publisher:American Heart Association
ISSN:2047-9980
ISSN (Online):2047-9980
Published Online:19 November 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Journal of the American Heart Association 10(23): e021494
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science