Undiagnosed airflow limitation in patients at cardiovascular risk

Impact of airflow limitation in chronic heart failure

Background

Comorbidities are common in chronic heart failure (HF) patients, but diagnoses are often not based on objective testing. Chronic obstructive pulmonary disease (COPD) is an important comorbidity and often neglected because of shared symptoms and risk factors. Precise prevalence and consequences are not well known. Therefore, we investigated prevalence, pulmonary treatment, symptoms and quality of life (QOL) of COPD in patients with chronic HF.

Methods

205 patients with stable HF for at least 1 month, aged above 50 years, were included from our outpatient cardiology clinic, irrespective of left ventricular ejection fraction. Patients performed post-bronchodilator spirometry, a six-minute walk test (6-MWT) and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). COPD was diagnosed according to GOLD criteria. Restrictive lung function was defined as FEV₁/FVC ≥0.70 and FVC <80% of predicted value. The BODE and ADO index, risk scores in COPD patients, were calculated.

Results

Almost 40% fulfilled the criteria of COPD and 7% had restrictive lung disease, the latter being excluded from further analysis. Noteworthy, 63% of the COPD patients were undiagnosed and 8% of those without COPD used inhalation therapy. Patients with COPD had more shortness of breath despite little difference in HF severity and similar other comorbidities. KCCQ was significantly worse in COPD patients. The ADO and BODE indices were significantly different.

Conclusion

COPD is very common in unselected HF patients. It was often not diagnosed and many patients received treatment without being diagnosed with COPD. Presence of COPD worsens symptoms and negatively effects cardiac specific QOL.

Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study

BACKGROUND

Retrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD - previously or newly diagnosed - in patients with IHD treated with PCI.

METHODS

Patients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed.

RESULTS

A total of 133 patients (78%) male, with a mean (SD) age of 63 (10.12) years were included. Of these, 33 (24.8%) met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%-75%]: 546-1,160). COPD patients had greater mortality (P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76-44.47) and number of cardiovascular events (P=0.024; HR: 1.87; 95% CI: 1.04-3.33), even those without a previous diagnosis of COPD (P=0.01; HR: 1.78; 95% CI: 1.12-2.83). These differences remained after adjustment for sex, age, number of coronary vessels affected, and previous myocardial infarction (P=0.025; HR: 1.83; 95% CI: 1.08-3.1).

CONCLUSION

Prevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients have an independent greater mortality and a higher number of cardiovascular events during follow-up.

Burden of cardiovascular disease in chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) and atherosclerotic vascular disease share several etiopathogenic factors.

PURPOSE

To compare the prevalence of self-reported cardiovascular and cerebrovascular disease (CCVD) between COPD and non-COPD subjects using the National Health and Nutrition Examination Survey (NHANES) database. Among subjects without pre-existent CCVD, the short-term and lifetime risks of future CCVD were also compared between the two groups.

METHODS

Pooled NHANES 2007-2010 data were analyzed in May 2012 and April 2013. Based on predicted Framingham risk, subjects without self-reported CCVD were classified as follows: high short-term risk, low short-term/high lifetime risk, and low short-term/low lifetime risk for future CCVD.

RESULTS

Estimated self-reported CCVD prevalence was 20.0% and 7.4% in COPD and non-COPD groups, respectively (p<0.001). On multivariable analysis, COPD was an independent risk factor for prevalent self-reported CCVD (prevalence ratio=1.4, 95% CI=1.1, 1.8). Among subjects without CCVD, there were significant differences in predicted future CCVD risk between the two groups. In the non-COPD group, prevalence of high short-term risk, low short-term/high lifetime risk, and low short-term/low lifetime risk was 18.9%, 62.7%, and 18.4%, respectively. In the COPD group, corresponding prevalence estimates were 35.8%, 53.2%, and 11.1%, respectively. Men and women had significantly different risk factor profiles for future CCVD.

CONCLUSIONS

The prevalence of self-reported CCVD was significantly higher in subjects with COPD than in those without COPD. Among subjects without pre-existent CCVD, the risk of future CCVD was significantly higher in the COPD group than in the non-COPD group.

Changes in lung function in older people from the English Longitudinal Study of Ageing

BACKGROUND

Decline in lung function with increasing age is common in older people. However, the rate of decline using the forced expiratory volume in 1 s (FEV1) in a longitudinal study in the elderly community dwellers is unknown.

METHODS

We analyzed data from the English Longitudinal Study of Ageing on people 50 years and older who had FEV1 measurement at Wave 2 and Wave 4 of 4 years of follow-up, respectively. A random coefficient model was employed to examine the changes in FEV1 and predict differences in the levels of FEV1 in older people.

RESULTS

A total of 4224 participants were included in the study. The mean (± standard deviation [SD]) rate of change in FEV1 was a decline of 32.92 ± 0.96 ml/year. The absolute difference in mean FEV1 level between female and male participants was 767.07 ± 16.6 ml. It was 253.91 ± 22.7 ml lower in current smokers than in nonsmokers, 73.67 ± 18.67 ml lower in participants with a history of sputum in winter months than in participants without sputum, 63.32 ± 7.07 ml lower in participants with a higher dyspnea score than in participants with a lower dyspnea score and 67.77 ± 15.87 ml higher in participants with good health compared to participants with fair/poor health status. One microgram increase in C-reactive protein level lowered FEV1 by 4.66 ± 0.86 ml and one Hb of hemoglobin increased the FEV1 level by 4.78 ± 0.77 ml. All were statistically significant at p < 0.001.

CONCLUSIONS

The average rate of FEV1 decline in older people without respiratory diseases was found to be high. Lower level of FEV1 was also observed in current smokers, females, those with a history of sputum in winter months and in participants with higher dyspnea score or in those with poorer health status.