What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with comorbid asthma/COPD and psychosocial distress (n=3117). Intervention: Comorbid asthma/COPD and psychosocial distress (PSD) vs. No asthma/COPD and no PSD. Primary outcome: Composite of 12-month hospitalization or death (HR 10.06, 95% CI 1.118-90.498, p=0.039).

What question did this study set out to answer?

To investigate how psychosocial distress affects prognosis in heart failure patients with asthma or chronic obstructive pulmonary disease based on heart failure severity.

April 4, 2026BJGP Open0 citationsOpen Access

Psychosocial distress in heart failure with asthma and chronic obstructive pulmonary disease

SBSigrid BoczorUniversität Hamburg MEMarion EiseleUniversität Hamburg ARAnja RakebrandtUniversität Hamburg

Key Result

In heart failure patients in NYHA class II, the combination of comorbid asthma or COPD and psychosocial distress was associated with a 10.06-fold higher hazard of 12-month hospitalization or death.

Key Points

To investigate how psychosocial distress affects prognosis in heart failure patients with asthma or chronic obstructive pulmonary disease based on heart failure severity.
Secondary analysis of the RECODE-HF observational cohort study
Utilized Kaplan-Meier curves and log-rank tests to assess hospitalization or death
Conducted Cox proportional hazards regression on 2499 patients to examine confounding factors
780 composite endpoints recorded, including 649 hospitalizations and 131 deaths
Significant reduction in mean time to composite endpoint by 31-93 days across various NYHA classes
Cox regression indicated a notable interaction affecting hospitalization and death risks based on NYHA class and comorbidity of asthma/COPD with psychosocial distress

Study Design

Type

Cohort (n=3,117)

Multicenter

Yes

Structured PICO

Does psychosocial distress worsen the 12-month prognosis of hospitalization or death in heart failure patients with comorbid asthma or COPD across different NYHA classes?

Population

3,117 chronic stable heart failure patients in primary care practices, mean age 73.9 years, 54.2% male, based in Germany. Subgroups include patients with comorbid asthma or COPD (n=953).

Intervention

Presence of psychosocial distress (PSD) and comorbid asthma or chronic obstructive pulmonary disease (COPD)

Comparator

Absence of psychosocial distress and/or absence of asthma/COPD (reference group in models: no-asthma-or-COPD and PSD-negative in NYHA class I)

Outcome

Composite endpoint of hospitalization or death at 12 monthscomposite

The combination of psychosocial distress and asthma/COPD in heart failure patients significantly worsens 12-month prognosis, particularly in those with NYHA class II symptoms.

Main Result

Effect estimate: HR 10.06 (95% CI 1.118-90.498)

p-value: p=0.039

Limitations

Asthma/COPD severity was not assessed by disease-specific classification such as lung function tests
Patient's NYHA class may have changed since the last visit
Psychosocial distress based on symptoms is not equated with a formal diagnosis of a mental disorder
Small sample sizes in some subgroups led to wide confidence intervals in the multivariable regression

Abstract

Background Investigations on the combination of the comorbidities heart failure (HF), asthma/chronic obstructive pulmonary disease (COPD), and psychosocial distress (PSD) differentiated by asthma/COPD and HF type or severity are scarce. Aim To investigate the impact of PSD on prognosis in HF patients with comorbid asthma/COPD depending on the HF severity. Design 131 deaths). Kaplan-Meier analysis revealed a significant reduction in estimated mean time to composite endpoint: -31 days (hazard ratio, HR 1.901;CI95% 1.325-2.674) in asthma/COPD/PSD+NYHA II; -47 days (HR 1.981;CI95% 1.364-2.879) and -40 days (HR 1.867;CI95% 1.361-2.561) in asthma/COPD/PSD+and no-asthma-or-COPD/PSD+in NYHA III; -93 days in no-asthma-or-COPD/PSD+NYHA IV (HR 2.457;CI95% 1.015-5.945) (reference no-asthma-or-COPD/PSD-; NYHA I). Cox regression showed a significant global three-way interaction regarding hospitalization or death between NYHA class, asthma/COPD, PSD ( P =0.037), and a 10.06-fold hazard (CI95% 1.118-90.498) regarding the NYHA class II subgroup*asthma/COPD*PSD ( P =0.039). Conclusion Comorbidity of HF, asthma/COPD and PSD showed an impact on prognosis by the NYHA functional class. Future research needs to investigate the special needs of patients with PSD and asthma/COPD with focus on those in NYHA class II. PSD screening seems relevant to identify patients with especially poor prognosis.

Ask AI

Helpful

Bookmark

View Full Paper