Clinical, Neurohormonal, and Inflammatory Markers and Overall Prognostic Role of Chronic Obstructive Pulmonary Disease in Patients With Heart Failure

Data From the Val-HeFT Heart Failure Trial

Lidia Staszewsky, Maylene Wong, Serge Masson, Simona Barlera, Elisa Carretta, Aldo P. Maggioni, Inder S. Anand, Jay N. Cohn, Gianni Tognoni, Roberto Latini

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and heart failure are major causes of death and disability. Because little information is available about the population of patients with both syndromes, we assessed the characteristics and the independent contribution of COPD to outcomes in patients with stable chronic heart failure. Methods: The clinical, neurohormonal, and echocardiographic characteristics of the 5010 patients enrolled in the Valsartan Heart Failure Trial were compared in patients with or without COPD. The prognostic value of COPD was tested by multivariate Cox proportional hazard models. Results: Patients with COPD were older, more symptomatic, and less likely to be receiving beta-blocker therapy, and had a higher mortality (27.4% vs. 18.4%, P < .0001). Echocardiographic parameters were not different, and brain natriuretic peptide was only minimally increased. Norepinephrine, inflammatory markers, cardiac troponin T, and creatinine values were significantly higher. After adjustment, COPD no longer predicted all-cause mortality but remained predictive of noncardiovascular mortality (hazard ratio 2.50; 95% confidence interval: 1.58-3.96; P < .0001) and hospitalizations, especially noncardiovascular (hazard ratio 1.71; 95% confidence interval; 1.43-2.06; P < .0001). Conclusions: Patients with COPD are more symptomatic and have worse outcomes that are not explained by poorer left ventricular function. After adjustment for demographic, clinical, biohumoral, and treatment variables, COPD is a weak predictor of all-cause mortality but a strong predictor of noncardiovascular events. Awareness and optimized treatment of heart failure and COPD may reduce the clinical burden of these patients.

Original languageEnglish (US)
Pages (from-to)797-804
Number of pages8
JournalJournal of Cardiac Failure
Volume13
Issue number10
DOIs
StatePublished - Dec 1 2007

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Chronic Obstructive Pulmonary Disease
Heart Failure
Mortality
Valsartan
Confidence Intervals
Troponin T
Brain Natriuretic Peptide
Treatment Failure
Left Ventricular Function
Proportional Hazards Models
Cause of Death
Creatinine
Norepinephrine
Hospitalization
Demography
Therapeutics
Population

Keywords

  • Cardiac failure
  • Chronic obstructive pulmonary disease
  • Clinical trials
  • Outcome

Cite this

Clinical, Neurohormonal, and Inflammatory Markers and Overall Prognostic Role of Chronic Obstructive Pulmonary Disease in Patients With Heart Failure : Data From the Val-HeFT Heart Failure Trial. / Staszewsky, Lidia; Wong, Maylene; Masson, Serge; Barlera, Simona; Carretta, Elisa; Maggioni, Aldo P.; Anand, Inder S.; Cohn, Jay N.; Tognoni, Gianni; Latini, Roberto.

In: Journal of Cardiac Failure, Vol. 13, No. 10, 01.12.2007, p. 797-804.

Research output: Contribution to journalArticle

Staszewsky, Lidia ; Wong, Maylene ; Masson, Serge ; Barlera, Simona ; Carretta, Elisa ; Maggioni, Aldo P. ; Anand, Inder S. ; Cohn, Jay N. ; Tognoni, Gianni ; Latini, Roberto. / Clinical, Neurohormonal, and Inflammatory Markers and Overall Prognostic Role of Chronic Obstructive Pulmonary Disease in Patients With Heart Failure : Data From the Val-HeFT Heart Failure Trial. In: Journal of Cardiac Failure. 2007 ; Vol. 13, No. 10. pp. 797-804.
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abstract = "Background: Chronic obstructive pulmonary disease (COPD) and heart failure are major causes of death and disability. Because little information is available about the population of patients with both syndromes, we assessed the characteristics and the independent contribution of COPD to outcomes in patients with stable chronic heart failure. Methods: The clinical, neurohormonal, and echocardiographic characteristics of the 5010 patients enrolled in the Valsartan Heart Failure Trial were compared in patients with or without COPD. The prognostic value of COPD was tested by multivariate Cox proportional hazard models. Results: Patients with COPD were older, more symptomatic, and less likely to be receiving beta-blocker therapy, and had a higher mortality (27.4{\%} vs. 18.4{\%}, P < .0001). Echocardiographic parameters were not different, and brain natriuretic peptide was only minimally increased. Norepinephrine, inflammatory markers, cardiac troponin T, and creatinine values were significantly higher. After adjustment, COPD no longer predicted all-cause mortality but remained predictive of noncardiovascular mortality (hazard ratio 2.50; 95{\%} confidence interval: 1.58-3.96; P < .0001) and hospitalizations, especially noncardiovascular (hazard ratio 1.71; 95{\%} confidence interval; 1.43-2.06; P < .0001). Conclusions: Patients with COPD are more symptomatic and have worse outcomes that are not explained by poorer left ventricular function. After adjustment for demographic, clinical, biohumoral, and treatment variables, COPD is a weak predictor of all-cause mortality but a strong predictor of noncardiovascular events. Awareness and optimized treatment of heart failure and COPD may reduce the clinical burden of these patients.",
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T1 - Clinical, Neurohormonal, and Inflammatory Markers and Overall Prognostic Role of Chronic Obstructive Pulmonary Disease in Patients With Heart Failure

T2 - Data From the Val-HeFT Heart Failure Trial

AU - Staszewsky, Lidia

AU - Wong, Maylene

AU - Masson, Serge

AU - Barlera, Simona

AU - Carretta, Elisa

AU - Maggioni, Aldo P.

AU - Anand, Inder S.

AU - Cohn, Jay N.

AU - Tognoni, Gianni

AU - Latini, Roberto

PY - 2007/12/1

Y1 - 2007/12/1

N2 - Background: Chronic obstructive pulmonary disease (COPD) and heart failure are major causes of death and disability. Because little information is available about the population of patients with both syndromes, we assessed the characteristics and the independent contribution of COPD to outcomes in patients with stable chronic heart failure. Methods: The clinical, neurohormonal, and echocardiographic characteristics of the 5010 patients enrolled in the Valsartan Heart Failure Trial were compared in patients with or without COPD. The prognostic value of COPD was tested by multivariate Cox proportional hazard models. Results: Patients with COPD were older, more symptomatic, and less likely to be receiving beta-blocker therapy, and had a higher mortality (27.4% vs. 18.4%, P < .0001). Echocardiographic parameters were not different, and brain natriuretic peptide was only minimally increased. Norepinephrine, inflammatory markers, cardiac troponin T, and creatinine values were significantly higher. After adjustment, COPD no longer predicted all-cause mortality but remained predictive of noncardiovascular mortality (hazard ratio 2.50; 95% confidence interval: 1.58-3.96; P < .0001) and hospitalizations, especially noncardiovascular (hazard ratio 1.71; 95% confidence interval; 1.43-2.06; P < .0001). Conclusions: Patients with COPD are more symptomatic and have worse outcomes that are not explained by poorer left ventricular function. After adjustment for demographic, clinical, biohumoral, and treatment variables, COPD is a weak predictor of all-cause mortality but a strong predictor of noncardiovascular events. Awareness and optimized treatment of heart failure and COPD may reduce the clinical burden of these patients.

AB - Background: Chronic obstructive pulmonary disease (COPD) and heart failure are major causes of death and disability. Because little information is available about the population of patients with both syndromes, we assessed the characteristics and the independent contribution of COPD to outcomes in patients with stable chronic heart failure. Methods: The clinical, neurohormonal, and echocardiographic characteristics of the 5010 patients enrolled in the Valsartan Heart Failure Trial were compared in patients with or without COPD. The prognostic value of COPD was tested by multivariate Cox proportional hazard models. Results: Patients with COPD were older, more symptomatic, and less likely to be receiving beta-blocker therapy, and had a higher mortality (27.4% vs. 18.4%, P < .0001). Echocardiographic parameters were not different, and brain natriuretic peptide was only minimally increased. Norepinephrine, inflammatory markers, cardiac troponin T, and creatinine values were significantly higher. After adjustment, COPD no longer predicted all-cause mortality but remained predictive of noncardiovascular mortality (hazard ratio 2.50; 95% confidence interval: 1.58-3.96; P < .0001) and hospitalizations, especially noncardiovascular (hazard ratio 1.71; 95% confidence interval; 1.43-2.06; P < .0001). Conclusions: Patients with COPD are more symptomatic and have worse outcomes that are not explained by poorer left ventricular function. After adjustment for demographic, clinical, biohumoral, and treatment variables, COPD is a weak predictor of all-cause mortality but a strong predictor of noncardiovascular events. Awareness and optimized treatment of heart failure and COPD may reduce the clinical burden of these patients.

KW - Cardiac failure

KW - Chronic obstructive pulmonary disease

KW - Clinical trials

KW - Outcome

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