Influence of Chronic Obstructive Pulmonary Disease on Long-term Hospitalization and Mortality in Patients with Heart Failure with Reduced Ejection Fraction

Abstract Background : Heart failure with reduced ejection fraction (HFrEF) can coexist with chronic obstructive pulmonary disease (COPD), which complicates the clinical situation and worsens quality of life. The study used standard diagnostic criteria for detecting COPD in hospitalized HFrEF patients and to determine the impact of other comorbidities and medications on the long-term outcomes of HFrEF + COPD patients. Methods : We retrospectively recruited patients hospitalized due to HFrEF in a tertiary medical center and examined and followed up clinical outcomes, including length of hospital stay, mortality, and readmission episodes, for a 5-year period. Risk factors for mortality were analyzed using multivariate analysis. Results : Of the 118 hospitalized HFrEF study participants, 68 had concurrent COPD whereas 50 did not. There was a significant increase in the male predominance, smoking history, lower left ventricular ejection fraction, and higher hemoglobin level and increased length of hospital stay in the HF + COPD group than in the HF-only group. In multivariate analysis, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use independently predicted 5-year all-cause mortality. Oral corticosteroid use and stroke as a comorbidity were independently associated with a shorter time to the first readmission episode. Conclusion : In HFrEF patients, COPD was associated with a prolonged length of hospital stay. ACEI/ARB use was independently associated with a beneficial effect on survival in HF patients with COPD. Long-term oral corticosteroid use in patients with both HF and COPD should be crucially evaluated to determine the clinical benefit and disadvantages.