COPD was associated with a higher risk of the composite of cardiovascular death or heart failure hospitalization (HR 1.18; 95% CI 1.05-1.34), while the benefit of sacubitril/valsartan over enalapril remained consistent.
RCT
Does sacubitril/valsartan improve outcomes compared to enalapril in HFrEF patients with comorbid COPD?
In patients with HFrEF, comorbid COPD is an independent predictor of hospitalization, but the therapeutic benefit of sacubitril/valsartan over enalapril is maintained in this high-risk subgroup.
Effect estimate: HR 1.18 (95% CI 1.05-1.34)
<0.001). After multivariable adjustment, COPD was associated with higher risks of heart failure hospitalization (hazard ratio HR, 1.32; 95% CI, 1.13-1.54), and the composite of cardiovascular death or heart failure hospitalization (HR, 1.18; 95% CI, 1.05-1.34), but not cardiovascular death (HR, 1.10; 95% CI, 0.94-1.30), or all-cause mortality (HR, 1.14; 95% CI, 0.99-1.31). COPD was also associated with higher risk of all cardiovascular hospitalization (HR, 1.17; 95% CI, 1.05-1.31) and noncardiovascular hospitalization (HR, 1.45; 95% CI, 1.29-1.64). The benefit of sacubitril/valsartan over enalapril was consistent in patients with and without COPD for all end points. Conclusions In PARADIGM-HF, COPD was associated with lower use of beta-blockers and worse health status and was an independent predictor of cardiovascular and noncardiovascular hospitalization. Sacubitril/valsartan was beneficial in this high-risk subgroup. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01035255.
Ehteshami‐Afshar et al. (Sat,) conducted a rct in Heart Failure With Reduced Ejection Fraction and Chronic Obstructive Pulmonary Disease. COPD vs. No COPD was evaluated on composite of cardiovascular death or heart failure hospitalization (HR 1.18, 95% CI 1.05-1.34). COPD was associated with a higher risk of the composite of cardiovascular death or heart failure hospitalization (HR 1.18; 95% CI 1.05-1.34), while the benefit of sacubitril/valsartan over enalapril remained consistent.