ATS 2019—Left heart failure potentially underdetected in patients with COPD


  • Tara Haelle
  • Conference Reports
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Takeaway

  • Patients with COPD and findings of left heart failure on echocardiograph have low rates of heart failure medication use, suggesting underdetection and undertreatment of heart failure.

Why this matters

  • Cardiovascular comorbidities worsen morbidity and outcomes in patients with COPD, but left heart failure diagnosis is difficult since symptoms overlap COPD symptoms.

Study design

  • Comparison of echocardiography and pharmacology for 1591 patients with COPD in German COSYCONET cohort with and without presumed systolic left heart failure, defined as echocardiography with left ventricular ejection fraction (LVEF) ≤50% or left ventricular end-diastolic diameter (LVEDD) >56 mm. 

Key results

  • 54.1% of patients had arterial hypertension.
  • 15% had systolic heart failure based on echocardiography (n=239).
  • FEV1 was slightly worse in patients with heart failure than without (55% vs 58%; P=.039).
  • Patients with heart failure vs without heart failure had:
    • Similar use of diuretics (21.8% vs 17.2%; P=.099).
    • Higher use of renin-angiotensin-aldosterone (RAAS) inhibitors (50.2% vs 42.0%; P=.029).
    • Higher use of beta-blockers (31.8% vs 19.2%; P<.001>
  • Excluding patients with isolated hypertension, 38% of patients LVEF ≤50% and 53% of patients LVEDD >56 mm not receiving heart failure medication.