Prognostic differences between heart failure with preserved versus reduced ejection fraction in people with COPD

Abstract

Background: COPD and heart failure (HF) commonly co-occur. However, the prevalence and relative prognostic impact of HF with preserved versus reduced left ventricular ejection fraction (LVEF) is not well described among those with both illnesses.

Aim: To compare clinical outcomes between people with COPD-HF with reduced ejection fraction (HFrEF, LVEF<40%) to those with COPD-HF with preserved ejection fraction (HFpEF>=50%).

Methods: We identified people with COPD-HF who had a LVEF measurement in the de-identified administrative claims database OptumLabs® DataWarehouse in the United States between 2008-2018. We compared risk of HF-admission, acute exacerbation due to COPD, mortality and healthcare use between HF phenotypes.

Results: From 5,419 people with COPD, 70% had HFpEF and 20% had HFrEF. Those with COPD-HFpEF were at increased risk of acute exacerbation of COPD (HR 0.75 95%CI 0.66-0.87), compared to those with COPD-HFrEF. Conversely, people with COPD-HFrEF had a greater risk of death (HR: 1.17, 95%CI 1.03-1.33) or HF-specific hospitalization (HR: 1.54, 95%CI 1.29-1.84) than COPD-HFpEF. There was a higher rate of long-term stays (admissions to nursing facilities) and emergency room visits for the COPD-HFpEF group, which also had the highest average pharmacy costs compared to the other HF phenotypes.

Conclusion: Among people with COPD and concomitant HF, HFpEF is the most common HF phenotype. Disease burden and healthcare utilization patterns differ between COPD-HFpEF and COPD-HFrEF and may require specific treatment approaches.