Chronic Obstructive Pulmonary Disease in Heart Failure with Reduced Ejection Fraction: Prevalence, Prognostic, and Association of Triple Inhaled Therapy

Background: The coexistence of heart failure with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) is a common health problem that complicates therapeutic management and worsens prognosis. Our aim was to analyse the association between COPD and HF treatment optimization, long-term clinical outcomes, mortality, and HF readmissions. Methods: A retrospective, observational study comparing two cohorts: HFrEF with COPD versus HFrEF without COPD. Beta-blocker (BB) and ivabradine dose optimization were assessed in both groups, and inhaled treatment was assessed in patients with COPD. Clinical outcomes during follow-up were analyzed using Kaplan–Meier methods and Cox proportional hazards regression. Results: 375 patients were included, of whom 71 had COPD (18.9%). No significant differences were observed between groups in BB or ivabradine dose optimization. After 60 months of follow-up, patients with COPD had higher rates of all-cause mortality (40.8% vs. 25.6%; p = 0.014), HF-related mortality (33.8% vs. 18.4%; p = 0.006), and HF readmission (50.7% vs. 35.2%; p = 0.014). COPD remained significantly associated with adverse clinical outcomes in multivariable Cox regression analysis. Among patients with COPD, dual inhaled therapy was the most common regimen (54.9%), followed by triple inhaled therapy (32.4%). Conclusions: In our cohort of patients with HFrEF, concomitant COPD was associated with higher mortality and HF readmission rates despite similar BB and ivabradine dose optimization between groups. These findings highlight the importance of COPD in the clinical management of patients with HFrEF, although the observational design of the study precludes causal conclusions. Further studies are warranted to clarify the relationship between COPD, HF outcomes, and treatment patterns.