Comorbidity of chronic heart failure of ischemic etiology and chronic obstructive pulmonary disease: 5-year follow-up

Abstract

BACKGROUND: The combination of chronic heart failure and chronic obstructive pulmonary disease contributes to the formation of the phenotype and survival of patients.

AIM: To study the 5-year prognosis and develop a prognostic model of adverse events in patients with chronic heart failure of ischemic origin in comorbidity with chronic obstructive pulmonary disease.

MATERIAL AND METHODS: Clinical signs of patients with chronic heart failure of ischemic origin (n=517), including those in combination with chronic obstructive pulmonary disease (n=118), and outcomes over 5 years according to end points: death from all causes, cardiovascular death, composite endpoint — all fatal and non-fatal cardiovascular events, were studied. Quantitative variables were presented as mean and standard deviation or median and interquartile range; categorical — in the form of absolute value and percentage. Quantitative intergroup differences were assessed using the Mann–Whitney test, and categorical differences were assessed using the Pearson χ² test. Time to event was analyzed using the Kaplan–Meier method; hazard ratio — by Cox regression. Models were developed using binary logistic regression. Statistical processing was carried out in the Jamovi, R 4.3.1 programs.

RESULTS: The clinical portrait of a patient with chronic heart failure of ischemic origin in the presence of chronic obstructive pulmonary disease was characterized by a predominance of men in older age groups, a high frequency of smoking, a worse quality of life, determined by the Minnesota Questionnaire, and a high level of high-sensitivity C-reactive protein, α₁- and α₂-globulins. Patients with heart failure in the presence of chronic obstructive pulmonary disease had higher overall and cardiovascular mortality (p=0.029 and p=0.02), the frequency of hospitalizations not related to cardiovascular disease (p=0.02), less non-fatal cardiovascular events (p=0.04).

CONCLUSION: In patients with heart failure, the presence of chronic obstructive pulmonary disease increased the risk of death from all causes by 2.07 times, cardiovascular mortality by 2.24 times, and achieving the combined endpoint by 1.68 times. Regression models were developed to determine the probability of risk of death from all causes and cardiovascular death.

Keywords

chronic heart failure / chronic obstructive pulmonary disease / prognosis

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