Takeaway
- Newly diagnosed heart failure (HF) and possible HF were associated with a similar increased risk of chronic obstructive pulmonary disease (COPD) exacerbation.
- Both incident and prevalent use of all HF medications were associated with a higher risk of exacerbation compared with non-use.
- The prevalent use of all HF medications was associated with a lower risk of exacerbation compared with incident use.
Why this matters
- Findings suggest that early diagnosis and optimal management of HF in primary care patients with COPD may reduce the risk of exacerbation.
Study design
- A retrospective cohort study included 86,795 patients with COPD (60,047 without HF, 8476 with possible HF, 2066 with newly diagnosed HF) from the UK Clinical Practice Research Datalink.
- Associations of incident use (<6 months of continuous exposure) and prevalent use (≥6 months of continuous exposure) of HF medications with COPD exacerbation were determined.
- Funding: NIHR Imperial Biomedical Research Centre.
Key results
- Newly diagnosed HF (adjusted HR [aHR], 1.45; 95% CI, 1.30-1.62) and possible HF (aHR, 1.65; 95% CI, 1.58-1.72) were associated with a similar increased risk of COPD exacerbation.
- The risk of exacerbation increased with:
- incident use of (aHR; 95% CI):
- angiotensin-converting enzyme inhibitor (ACEi; 5.38; 4.79-6.05);
- angiotensin receptor blocker (ARB; 5.99; 5.08-7.07);
- beta-blocker (BB; 5.65; 4.92-6.49);
- loop diuretics (LD; 4.76; 4.31-5.25); and
- mineralocorticoid receptor antagonist (MRA; 6.01; 5.31-6.80).
- prevalent use of (aHR; 95% CI):
- ACEi (1.11; 1.03-1.19);
- ARB (1.22; 1.12-1.32);
- BB (1.41; 1.32-1.51);
- LD (1.12; 1.05-1.20); and
- MRA (1.61; 1.48-1.74).
- incident use of (aHR; 95% CI):
- The risk of exacerbation decreased with the prevalent vs incident use of (aHR; 95% CI):
- ACEi (0.24; 0.22-0.27);
- ARB (0.23; 0.20-0.26);
- BB (0.27; 0.25-0.30);
- LD (0.25; 0.23-0.27); and
- MRA (0.32; 0.28-0.35).
Limitations
- Retrospective design.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.