Heart Failure and COPD: Common Partners, Common Problems. Nat Hawkins Liverpool Heart and Chest Hospital

Transcription

1 Heart Failure and COPD: Common Partners, Common Problems Nat Hawkins Liverpool Heart and Chest Hospital

2 Disclosures: No conflicts of interest

3 Common partners, common problems COPD in HF common partners HF in COPD symptoms common problems prognosis diagnosis treatment

4 How common is COPD in stable HF? 374,893 patients in primary care 25 23, ,1 0 General Population Heart Failure Hawkins NM. Eur J Heart Fail 2010: 12(1):1-8.

5 How common is COPD in stable HF? 374,893 patients in primary care , ,0 16,9 5 3,1 0 General population Elderly > 65 years Heart failure non-smoker Heart failure smoker Hawkins NM. Data on file.

6 Prevalence of COPD in stable HF in Europe Hawkins NM. Eur J Heart Fail 2009: 11(2):

7 Prevalence of COPD in acute HF in Europe Hawkins NM. Eur J Heart Fail 2009: 11(2):

8 Prevalence of COPD in stable HF in North America Hawkins NM. Eur J Heart Fail 2009: 11(2):

9 Prevalence of COPD in acute HF in North America Hawkins NM. Eur J Heart Fail 2009: 11(2):

10 Increasing prevalence of COPD in HF: cohort series First Year Last Year Kaiser Permanente Boston Medicare Medicare Scotland Barker DW. Circulation 2006;113: Polanczyk CA. Arch Intern Med 2000;160: Baker DW. Am Heart J 2003; 146: Kosiborod M. Am J Med 2006; 119: Hawkins NM. Eur J Heart Fail 2010; 12(1):1-8.

11 Prevalence of COPD in HF: Cardiology vs general medicine Cardiology Medicine n= n= n= n=403 Auerbach AD. Ann Intern Med 2000; 132: Philbin EF. Am Heart J 2000; 139: Jong P. Circulation 2003; 108: Ansari M. J Am Coll Cardiol 2003; 41:62-68.

12 Prevalence of COPD in HF: Preserved vs reduced EF Preserved Reduced COPD is more prevalent in HF with preserved EF Hawkins NM. Eur J Heart Fail 2009: 11(2):

13 Prevalence of COPD in HF: Socioeconomic status 374,893 patients in primary care 35 Rate Ratio 1.27 [ ], p= Least Deprived Most Deprived Hawkins NM. Eur J Heart Fail 2010: 12(1):1-8.

14 Prevalence some considerations population spirometry ageing cut-offs risk factors changing criteria smoking pulmonary disease burden definition oedema surveillance spirometry awareness clinical coding screening self reported contact with medication services

15 Discord between self-reported COPD and spirometry Spirometry confirms Spirometry refutes 489 consecutive patients hospitalised with HF prevalence of COPD 35% ,3 33% with self-reported COPD refuted by spirometry ,2 14,7 Self-report present 19,8 Self-report absent 25% without self-reported COPD airflow obstruction on spirometry Iversen KK. J Intern Med 2008: 264(4):

16 Prognostic significance of COPD in HF Independent predictor of 1 year mortality Gustafsson Lee Goldberg 1,36 1,41 1,39 Braunstein Alexander Jong 1,12 1,13 1,19 Senni 1,41 Siirila-Waris 1,20-0,5 0 0,5 1 1,5 2 2,5 Relative Risk or Odds Ratio (± 95% CI) Hawkins NM. Eur J Heart Fail 2009: 11(2):

17 Prevalence of HF in COPD Italian Health Search Database n=341, % prevalence HF in COPD overall Scottish Continuous Morbidity Record n=377, % prevalence HF in COPD overall Cazzola M. Respiration 2010; epub; Hawkins NM. Data on file.

18 Prevalence of LVSD in COPD high prevalence selected populations severe COPD suspected LVSD coronary disease Rutten FH. Eur J Heart Fail 2006: 8(7):

19 Prevalence of unrecognised HF in COPD primary care patients with COPD 65 years (n=405) diagnosis by consensus opinion of expert panel after extensive work-up symptoms and echocardiographic systolic or diastolic dysfunction Rutten FH. Eur Heart J 2005: 26(18):

20 Survival Prognostic significance of HF in COPD doubles mortality of patients with COPD primary care patients with COPD 65 years (n=405) COPD COPD GOLD COPD + Heart Failure COPD GOLD + Heart Failure adjusted HR 2.1 ( ) Time (Months) Boudestein LC. Eur J Heart Fail 2009; 11(12):

21 Relationship between COPD and HF: Causal or confounded? COPD? Causal HF Associated Causal Pro low grade inflammation atherosclerosis myocardial injury FEV 1 predicts CV events CV Risk Factors Contra CV Health Study Copenhagen Study COPD not independent predictor of HF or LVSD

22 Potential Confounders independent predictors of atherosclerotic events in VALIANT (n=14703) Smoking BP Diabetes Lipids Diet Activity Socioeconomic Obesity Occupation CVD CAD CVA PVD CKD Predictor Hazard Ratio (95% CI) Diabetes 1.36 ( ) Age (per 10 years) 1.17 ( ) Angina 1.31 ( ) Previous MI 1.28 ( ) Killip Class ( ) Killip Class ( ) Previous stroke 1.28 ( ) Heart failure post-mi 1.19 ( ) Heart rate (per 10 bpm) 1.06 ( ) Current smoker 1.21 ( ) Previous unstable angina 1.17 ( ) Hypertension 1.17 ( ) Angina post-mi 1.16 ( ) Peripheral vascular disease 1.19 ( ) Killip Class ( ) New diabetes 1.28 ( ) Left bundle branch block 1.23 ( ) Weight (per 10 kg) 1.55 ( ) Previous CABG 1.19 ( ) Previous heart failure 1.13 ( ) COPD 0.98 ( ) Hawkins NM. Eur J Heart Fail 2009: 11(3):

23 THE HF SPECTRUM Less challenging More challenging Young Few co-morbidities Old Multiple comorbidities Polypharmacy

24 THE HF SPECTRUM Less challenging More challenging Young Few co-morbidities Old Multiple comorbidities Polypharmacy Population

25 THE HF SPECTRUM Less challenging More challenging Young Few co-morbidities Old Multiple comorbidities Polypharmacy Population Cardiology involvement

26 Conclusions COPD is common in HF and independently predicts mortality HF is common in COPD and independently predicts mortality Cardiovascular risk factors cluster in patients with COPD As we shall see, numerous symptomatic, diagnostic and therapeutic problems

27 Thank you Any questions?