Wiener klinische Wochenschrift

, Volume 121, Issue 9–10, pp 309–313 | Cite as

The burden of chronic obstructive pulmonary disease in patients hospitalized with heart failure

  • Mitja Lainscak
  • Lea Majc Hodoscek
  • Hans-Dirk Düngen
  • Mathias Rauchhaus
  • Wolfram Doehner
  • Stefan D. Anker
  • Stephan von Haehling
Original article


OBJECTIVES: Like chronic heart failure, chronic obstructive pulmonary disease (COPD) is an enormous public health problem in industrialized countries. Our aim was to determine the prevalence and clinical impact of COPD among patients hospitalized for heart failure in a community hospital serving a population of 125,000 people. METHODS: Between 2001 and 2003 a total of 638 patients (73 ± 10 years, 48% men, 74% NYHA class III) were identified with a discharge diagnosis of heart failure. Medical charts were reviewed and vital status was obtained from a Central Population Registry. RESULTS: COPD was diagnosed in 106 (17%) patients whose age was similar to those without COPD (73 ± 9 vs. 73 ± 11 years, P = 0.35). Patients with COPD were more often males (65% vs. 45%, P < 0.001). There were no differences in arterial hypertension, atrial fibrillation, diabetes mellitus and most laboratory markers except hemoglobin (141 ± 20 vs. 132 ± 20 g/l, P < 0.001) and uric acid (453 ± 136 vs. 414 ± 139 mmol/l, P = 0.013). At discharge, patients with COPD were less likely to receive beta-blockers (12% vs. 28%, odds ratio 0.35, 95% CI0.19–0.64). During follow-up, patients with COPD had higher mortality (73% vs. 60%, P = 0.016, hazard ratio 1.48, 95% CI 1.15–1.90). Kaplan–Meier (log-rank test, P = 0.002) and Cox proportional hazard analysis, adjusted for age, sex, hemoglobin, uric acid, and treatment with beta-blockers and furosemide (hazard ratio 1.38, 95% CI1.04–1.83, P = 0.024) demonstrated the prognostic importance of COPD. CONCLUSIONS: COPD is frequent among hospitalized patients with heart failure. Beta-blockers are largely underused, which is probably a major reason for the higher mortality observed in patients with concomitant chronic heart failure and COPD.


Chronic heart failure Chronic obstructive pulmonary disease Mortality 


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  1. Dickstein K, Cohen-Solal A, Filippatos G, Mc Murray JJ, Ponikowski P, Poole-Wilson PA, et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur J Heart Fail 10: 933–989PubMedCrossRefGoogle Scholar
  2. Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, et al (2003) The EuroHeart Failure survey programme – a survey on the quality of care among patients with heart failure in Europe; Part 1: patient characteristics and diagnosis. Eur Heart J 24: 442–463PubMedCrossRefGoogle Scholar
  3. Lainscak M, Cleland JG, Lenzen MJ, Follath F, Komajda M, Swedberg K (2007) International variations in the treatment and co-morbidity of left ventricular systolic dysfunction: data from the EuroHeart Failure Survey. Eur J Heart Fail 9: 292–299PubMedCrossRefGoogle Scholar
  4. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al for the Global Initiative for Chronic Obstructive Lung Disease (2007) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176: 532–555PubMedCrossRefGoogle Scholar
  5. Firlei N, Lamprecht B, Schirnhofer L, Kaiser B, Studnicka M (2007) The prevalence of COPD in Austria – the expected change over the next decade. Wien Klin Wochenschr 119: 513–518PubMedCrossRefGoogle Scholar
  6. Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJV (2009) Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 11: 130–139PubMedCrossRefGoogle Scholar
  7. Padeletti M, Jelic S, LeJemtel TH (2008) Coexisting chronic obstructive pulmonary disease and heart failure in the elderly. Int J Cardiol 125: 209–215PubMedCrossRefGoogle Scholar
  8. Andreas S, Anker SD, Scanlon PD, Somers VK (2005) Neurohumoral activation as a link to systemic activation of chronic lung disease. Chest 128: 3618–3624PubMedCrossRefGoogle Scholar
  9. von Haehling S, Lainscak M, Springer J, Anker SD (2009) Cardiac cachexia: A systematic overview. Pharmacol Ther 121: 227–252PubMedCrossRefGoogle Scholar
  10. Rutten FH, Cramer MJ, Lammers JW, Grobbee DE, Hoes AW (2006) Heart failure and chronic obstructive pulmonary disease: an ignored combination? Eur J Heart Fail 8: 706–711PubMedCrossRefGoogle Scholar
  11. Rusinaru D, Saaidi I, Godard S, Mahjoub H, Battle C, Tribouilloy C (2008) Impact of chronic obstructive pulmonary disease on long-term outcome of patients hospitalized for heart failure. Am J Cardiol 101: 353–358PubMedCrossRefGoogle Scholar
  12. Similkowski T, Agusti A, MacNee W, Schönhofer B (2006) The potential impact of anemia of chronic disease in COPD. Eur Respir J 27: 390–396CrossRefGoogle Scholar
  13. John M, Lange A, Hoernig S, Witt C, Anker SD (2006) Prevalence of anemia in chronic obstructive pulmonary disease: comparison to other chronic diseases. Int J Cardiol 111: 365–370PubMedCrossRefGoogle Scholar
  14. Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, et al (2003) Uric acid and survival in chronic heart failure: Validation and application in metabolic, functional, and hemodynamic staging. Circulation 107: 1991–1997PubMedCrossRefGoogle Scholar
  15. Shelton RJ, Rigby AS, Cleland JGF, Clark AL (2006) Effect of a community heart failure clinic on uptake of β-blockers in patients with obstructive airways disease and heart failure. Heart 92: 331–336PubMedCrossRefGoogle Scholar
  16. Kotlyar E, Keogh AM, Macdonald PS, Arnold RH, McCaffrey DJ, Glanville AR (2002) Tolerability of carvedilol in patients with heart failure and concomitant chronic obstructive pulmonary disease or asthma. J Heart Lung Transplant 21: 1290–1295PubMedCrossRefGoogle Scholar
  17. Adamson PB, Gilbert EM (2006) Reducing the risk of sudden death in heart failure with β-blockers. J Card Fail 12: 734–746PubMedCrossRefGoogle Scholar
  18. Doehner W, Anker SD (2008) Beta blockers and glucose metabolism in chronic heart failure: friend or foe? Clin Res Cardiol 97: 21–23PubMedCrossRefGoogle Scholar
  19. Kovaˇić D, Marinsek M, Gobec L, Lainscak M, Podbregar M (2008) Effect of selective and non-selective beta-blockers on body weight, insulin resistance and leptin concentration in chronic heart failure. Clin Res Cardiol 97: 24–31CrossRefGoogle Scholar
  20. Lainscak M, Keber I, Anker SD (2006) Body composition changes in patients with systolic heart failure treated with beta blockers: a pilot study. Int J Cardiol 106: 319–322PubMedCrossRefGoogle Scholar
  21. Lainscak M, Andreas S, Scanlon PD, Somers VK, Anker SD (2006) Ghrelin and neurohumoral antagonists in the treatment of cachexia associated with cardiopulmonary disease. Intern Med 45: 837PubMedCrossRefGoogle Scholar
  22. Fuster V, Ryden LE, Cannon DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al (2006) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation – executive summary. Eur Heart J 27: 1979–2030PubMedCrossRefGoogle Scholar
  23. Lainscak M, Dagres N, Filippatos GS, Anker SD, Kremastinos DT (2008) Atrial fibrillation in chronic non-cardiac disease: where do we stand? Int J Cardiol 128: 311–315PubMedCrossRefGoogle Scholar
  24. Lainscak M, Cleland JG, Lenzen MJ, Nabb S, Keber I, Follath F, et al (2007) Recall of lifestyle advice in patients recently hospitalised with heart failure: a EuroHeart Failure survey analysis. Eur J Heart Fail 9: 1095–1103PubMedCrossRefGoogle Scholar
  25. Hülsmann M, Pacher R (2002) Warum Herzinsuffizienzenanbulanzen? Wien Klin Wochenschr 114: 819–821PubMedGoogle Scholar
  26. Lainscak M, Farkas J (2008) Challenges of beta blocker therapy in chronic heart failure: the story continues. Eur J Cardiovasc Nurs 7: 159–160PubMedCrossRefGoogle Scholar
  27. Macchia A, Monte S, Romero M, D'Ettore A, Tognoni G (2007) The prognostic influence of chronic obstructive pulmonary disease in patients hospitalized for chronic heart failure. Eur J Heart Fail 9: 942–948PubMedCrossRefGoogle Scholar
  28. Staszewsky L, Wong M, Masson S, Barlera S, Carretta E, Maggioni AP, et al (2007) Clinical, neurohormonal, and inflammatory markers and overall prognostic role of chronic obstructive pulmonary disease in patients with heart failure: data from Val-HeFT heart failure trial. J Card Fail 13: 797–804PubMedCrossRefGoogle Scholar
  29. Lainscak M, von Haehling S, Anker SD (2009) Natriuretic peptides and other biomarkers in chronic heart failure: from BNP, NT-proBNP, and MR-proANP to routine biochemical markers. Int J Cardiol 132: 303–311PubMedCrossRefGoogle Scholar
  30. Maisel A, Mueller C, Adams K Jr, Anker SD, Aspromante N, Cleland JG, et al (2008) State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail 10: 824–839PubMedCrossRefGoogle Scholar
  31. Hernandez AF, Hammill BG, O'Connor CM, Schulman KA, Curtis LH, Fonarow GC, et al (2009) Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry. J Am Coll Cardiol 53: 184–192PubMedCrossRefGoogle Scholar
  32. Lainscak M, Moullet C, Schön N, Tendera M (2007) Treatment of chronic heart failure with carvedilol in daily practice: the SATELLITE survey experience. Int J Cardiol 122: 149–155PubMedCrossRefGoogle Scholar
  33. Lainscak M, Keber I (2006) Patients' knowledge and beta blocker treatment improve prognosis of patients from a heart failure clinic. Eur J Heart Fail 8: 187–190PubMedCrossRefGoogle Scholar
  34. Düngen HD, Apostolović S, Inkrot S, Tahirović E, Krackhardt F, Pavlović M, et al; CIBIS-ELD Investigators, Subproject Multicenter Trials in the Competence Network Heart Failure (2008) Bisoprolol vs. carvedilol in elderly patients with heart failure: rationale and design of the CIBIS-ELD trial. Clin Res Cardiol 97: 578–586PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Mitja Lainscak
    • 1
    • 2
  • Lea Majc Hodoscek
    • 3
  • Hans-Dirk Düngen
    • 4
  • Mathias Rauchhaus
    • 5
  • Wolfram Doehner
    • 2
    • 6
  • Stefan D. Anker
    • 2
    • 7
  • Stephan von Haehling
    • 2
  1. 1.Division of CardiologyUniversity Clinic of Respiratory and Allergic Diseases GolnikGolnikSlovenia
  2. 2.Applied Cachexia Research, Department of CardiologyCharité Medical School, Campus Virchow-KlinikumBerlinGermany
  3. 3.Department of Internal MedicineGeneral Hospital Murska SobotaMurska SobotaSlovenia
  4. 4.Competence Network Heart Failure, Department of Internal Medicine – CardiologyCharité – Campus Virchow-KlinikumBerlinGermany
  5. 5.Heart Failure Programme, Department of Cardiology, Center for Interval Medicine IUniversity Hospital RostockGermany
  6. 6.Center for Stroke Research BerlinCharitéBerlinGermany
  7. 7.Center for Clinical and Basic ResearchIRCCS San RaffaeleRomeItaly

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