title: Impact of chronic obstructive pulmonary disease severity on symptoms and prognosis in patients with systolic heart failure.
abstract: BACKGROUND
  Systolic heart failure (SHF) and chronic obstructive pulmonary disease (COPD) are frequently associated. The purpose of our study was to explore the impact of COPD severity on symptoms and prognosis in patients with SHF.
  
  
  RESULTS
  Chronic obstructive pulmonary disease was systematically screened by spirometry in 348 patients admitted for SHF from April 2002 to December 2006. Severity of COPD was defined according to the GOLD classification. Prevalence of COPD was 37.9 %. Patients' distribution according to GOLD stages I, II, II and IV were, respectively, 51.5, 37.9, 7.6 and 3.0 %. Severity of dyspnoea increases with GOLD stage. There was a significant correlation between NYHA stage and left ventricular ejection fraction in patients without COPD (R                            (2) = 0.03; P = 0.01) but not in patients with COPD. Mean follow-up was of 54.9 ± 27.4 months. Mortality was 46.6 % and was highest in the COPD group (53.8 vs. 42.3 %; P = 0.049). Kaplan-Meier survival curves showed that patients with GOLD stage I had the same prognosis than patients without COPD and mortality increased from GOLD stage II to stage IV. After multivariate analysis, GOLD stage and diuretics' dose were independently associated with mortality.
  
  
  CONCLUSIONS
  Chronic obstructive pulmonary disease is frequent in patients with SHF and increases mortality. Since dyspnoea is poorly specific of COPD in chronic heart failure patients, COPD remains underdiagnosed thus leading to inappropriate increase of diuretics' dose. COPD should be systematically screened in patients with SHF to adapt prescription of selective β1-blockers, and diuretics' dose and reduce the exposition to risk factors.
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse Cedex, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Arnaudis
authors.forename: Olivier
authors.initials: O
authors.lastname: Lairez
authors.forename: Roger
authors.initials: R
authors.lastname: Escamilla
authors.forename: Audrey
authors.initials: A
authors.lastname: Fouilloux
authors.forename: Pauline
authors.initials: P
authors.lastname: Fournier
authors.forename: Benoit
authors.initials: B
authors.lastname: Monteil
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bouisset
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Arnal
authors.forename: Meyer
authors.initials: M
authors.lastname: Elbaz
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Jérôme
authors.initials: J
authors.lastname: Roncalli
authors.forename: Atul
authors.initials: A
authors.lastname: Pathak
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
mesh_terms: D000328:Adult; D000368:Aged; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry
chemical_list: D004232:Diuretics