Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common co-morbidities. The combination presents diagnostic challenges and has been linked with worse prognosis in patients admitted to hospital. There is hardly any prognostic data in patients with both co-morbidities in the community.Methods and Results
We evaluated 783 patients (27.2%) with left ventricular systolic dysfunction under the care of a regional nurse-led community HF team between June 2007 and June 2010. 101 patients (12.9%) also had a diagnosis of COPD. 94% of patients were on loop diuretics; 83% on ACE inhibitors, 74% on β-blockers; 10.6% were on bronchodilators and 42% on aldosterone antagonists. Mean age of the patients was 77.9±5.7 years; 43% were females and mean NYHA class was 2.3±0.6. Mean follow-up was 28.2±2.9 months. β-Blocker utilisation was markedly lower in patients receiving bronchodilators compared to those without (overall 21.7% vs 81%; p<0.001). 24-month survival (Abstract P232 figure 1) was 93% in patients with HF alone and 89% in those with both co-morbidities (p=NS). The presence of COPD was associated with increased HF hospitalisations [HR 1.56 (1.4 to 2.1); p<0.001] and major adverse cardiovascular events [HR 1.23 (1.03 to 1.75); p<0.001].Conclusions
COPD is a common co-morbidity in ambulatory HF patients in the community and is a powerful predictor of worsening HF. It does not however appear to affect short-term mortality in ambulatory HF patients.