Impacto pronóstico de la enfermedad pulmonar obstructiva crónica y el asma bronquial en pacientes con insuficiencia cardiaca

Abstract

Purpose

To analyze the impact of chronic obstructive pulmonary disease (COPD) and bronchial asthma on therapeutic management and prognosis of patients with heart failure (HF).

Methods

Analysis of the information collected in a clinical registry of patients referred to a specialized HF unit from January-2010 to June-2012. Clinical profile, treatment and prognosis of patients was evaluated, according to the presence of COPD or asthma. Survival analyses were conducted by means of Kaplan-Meier and Cox's methods. Median follow-up was 1493 days.

Results

We studied 2577 patients, of which 251 (9.7%) presented COPD and 96 (3.7%) bronchial asthma. Significant differences among study groups were observed regarding to the prescription of beta-blockers (COPD = 89.6%; asthma = 87.5%; no bronchopathy = 94.1%; P = .002) and SGLT2 inhibitors (COPD = 35.1%; asthma = 50%; no bronchopathy = 38.3%; P = .036). Also, patients with bronchial disease received less frequently a defibrillator (COPD = 20.3%; asthma = 20.8%; no broncopathy = 29%; P = .004).

COPD was independently associated with increased risk of all-cause mortality (HR = 1.64; 95% CI: 1.33-2.02), all-cause death or HF admission (HR = 1.47; 95% CI: 1.22-1.76) and cardiovascular death or heart transplantation (HR = 1.39; 95% CI: 1.08-1.79) as compared with patients with no bronchopathy. Bronchial asthma was not significantly associated with increased risk of adverse outcomes.

Conclusions

COPD, but not asthma, is an adverse independent prognostic factor in patients with HF.