title: The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST Trial.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is prevalent in heart failure (HF) patients, yet these patients are poorly characterized. We aimed to describe the characteristics and outcomes of patients with systolic dysfunction and COPD in a contemporary HF randomized trial.
  
  
  RESULTS
  EVEREST investigated 4,133 patients hospitalized with worsening HF and an ejection fraction (EF) ≤40%. We analyzed the characteristics and outcomes (all-cause mortality and cardiovascular mortality/HF hospitalization) of patients according to baseline COPD status. COPD was present in 10% (n = 416) of patients. Patients with COPD had a higher prevalence of comorbidities and were less likely to receive a β-blocker, angiotensin-converting enzyme inhibitor, or aldosterone antagonist. On univariate analysis, COPD was associated with increased all-cause mortality (HR 1.41, 95% CI 1.18-1.67) and cardiovascular mortality/HF hospitalization (HR 1.29, 95% CI 1.11-1.49). After adjusting for potential confounders, the risk associated with COPD remained increased, but was not statistically significant.
  
  
  CONCLUSIONS
  The presence of COPD in HF patients is associated with an increased burden of comorbidities, lower use of HF therapies, and a trend toward worse outcomes. These findings provide a starting point for prospective investigations of the treatment of HF comorbidities to reduce the high postdischarge event rates.
authors: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
authors: Robert J
authors: RJ
authors: Mentz
authors: Philip H
authors: PH
authors: Schmidt
authors: Mary J
authors: MJ
authors: Kwasny
authors: Andrew P
authors: AP
authors: Ambrosy
authors: Christopher M
authors: CM
authors: O'Connor
authors: Marvin A
authors: MA
authors: Konstam
authors: Faiez
authors: F
authors: Zannad
authors: Aldo P
authors: AP
authors: Maggioni
authors: Karl
authors: K
authors: Swedberg
authors: Mihai
authors: M
authors: Gheorghiade
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D054143:Heart Failure, Systolic / Q000188:drug therapy / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D013318:Stroke Volume
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists