Trends in heart failure incidence in the UK COPD population

  • Axson EL & al.
  • Ann Am Thorac Soc
  • 10 Apr 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • The incidence of heart failure (HF) in the UK primary care chronic obstructive pulmonary disorder (COPD) population was steady in the last decade.
  • Patients with COPD and incident HF (COPD-iHF) experienced significantly higher mortality vs patients with COPD and without HF (COPD-no HF).
  • The mortality rates of patients with COPD-iHF have not improved over the last decade.

Why this matters

  • Findings suggest that HF remains under-diagnosed in patients with COPD and that, when recognised, maybe under-treated leading to poor survival.
  • Bespoke guidelines for the diagnosis and management of HF in the COPD population are needed to improve diagnosis and outcome.

Study design

  • This study calculated the annual incidence of HF in 95,987 HF-naïve patients with COPD using data from the UK Clinical Practice Research Datalink (CPRD) from 2006 to 2016.
  • Association between incident HF with short- and long-term mortality was also evaluated in this population.
  • Funding: The National Institute for Health Research (NIHR) Imperial Biomedical Research Centre.

Key results

  • The crude incidence of HF was steady in patients with COPD from 2006 to 2016 (1.18 per 100 person-years; 95% CI, 1.09-1.27).
  • In patients with COPD, incident HF was associated with a >3-fold increase in 1-year mortality and a 2-fold increase in 5- and 10-year mortality vs patients with COPD-no HF with no change based on year of HF diagnosis.
  • The effect of incident HF on the mortality of patients with COPD did not improve over time.
    • 2011 (1-year adjusted mortality rate ratio [aMRR], 1.26; 95% CI, 0.83-1.90 and 5-year aMRR, 1.26; 95% CI, 0.98-1.61),
    • 2015 (1-year aMRR, 1.63; 95% CI, 0.98-2.70).

Limitations

  • Validity of case definitions within electronic health care records.