The improved survival rates that have been achieved for patients with heart failure (HF) are not being seen in chronic obstructive pulmonary disease (COPD) patients with incident HF (COPD-iHF), according to research carried out by a team at Imperial College London.
Using data from the Clinical Practice Research Datalink (CPRD), the study identified 181,705 COPD patients without HF at the start of follow-up. Age- and sex-adjusted mortality rate ratios were calculated for one-, five- and 10-year mortality for COPD-iHF in 2006, 2011 and 2015 and compared with COPD patients without iHF (COPD-no iHF).
The study revealed that patients with COPD-iHF experienced three times greater one-year mortality (2006: adjusted hazard ratio [aHR], 3.31; 95% CI, 2.70-4.06) and two times greater five- (2006: aHR, 2.35; 95% CI, 2.08-2.66) and 10-year mortality (2006: aHR, 1.95; 95% CI, 1.75-2.17) than COPD-no iHF patients and this did not change based on year of HF diagnosis.
One- and five-year mortality did not improve over time comparing COPD-iHF in 2011 (one-year aHR, 0.97; 95% CI, 0.74-1.27; five-year aHR, 1.07; 95% CI, 0.90-1.26) and 2015 (one-year aHR, 1.11; 95% CI, 0.83-1.50) to COPD-iHF in 2006.
The authors say the findings show that COPD-iHF patients have not seen the same survival gains over the past decade as the general population with iHF. They say this may reflect continued under-treatment of cardiovascular conditions and the delayed diagnosis of HF within the COPD population.
The absence of or delayed access to survival modifying cardiovascular medications in the COPD population with HF may account for the lack of survival gains in this population, they add. The call for bespoke guidelines for the diagnosis and management of HF in the COPD population in order to improve survival.
The research was presented at the British Thoracic Society Winter Meeting.
