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COPD in chronic heart failure: less common than previously thought?
Armine G Minasian1, Frank J J van den Elshout, P N Richard Dekhuijzen
1Department of Pulmonary Diseases, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands. aminasian@rijnstate.nl
Heart & Lung : the Journal of Critical Care
|September 4, 2013
Summary
Defining chronic obstructive pulmonary disease (COPD) using the lower limit of normal (LLN) identifies clinically significant COPD in heart failure (HF) patients more accurately than a fixed ratio. This reduces overdiagnosis and unnecessary treatments.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Diagnostic Criteria
Background:
- Overdiagnosis of chronic obstructive pulmonary disease (COPD) in elderly patients with heart failure (HF) is a concern when using a fixed ratio (FEV1/FVC < 0.70) for diagnosis.
- This can lead to unnecessary treatments and potential adverse health effects.
Purpose of the Study:
- To compare COPD prevalence in stable chronic heart failure patients using two definitions of airflow obstruction: the lower limit of normal (LLN) and the fixed ratio (GOLD criteria).
Main Methods:
- Spirometry was conducted on 187 outpatients with stable chronic HF (LVEF <40%).
- COPD diagnosis was confirmed after 3 months of standard tiotropium treatment for newly diagnosed cases.
- Patients were assessed based on LLN and fixed ratio criteria.
Main Results:
- COPD prevalence differed significantly: 19.8% using LLN versus 32.1% using the fixed ratio (GOLD).
- A substantial proportion (38.3%) of patients diagnosed with GOLD-COPD (FEV1/FVC < 0.7 but > LLN) were potentially misclassified.
- Misclassified patients showed no significant differences in respiratory symptoms or risk factors compared to those without COPD.
Conclusions:
- Using LLN instead of a fixed ratio reduced the estimated prevalence of COPD in chronic HF patients from one-third to one-fifth.
- The LLN criteria may better identify clinically relevant COPD in this population compared to the fixed ratio of 0.7.
Keywords:
ABHRACE-IARBATS/ERSAmerican Thoracic Society/European Respiratory SocietyBMICABGCOPDCRTCSChronic heart failureChronic obstructive pulmonary diseaseFEV(1)/FVCFSFixed ratioGOLDGlobal Initiative for Chronic Obstructive Lung DiseaseHFICDLLNLVEFLVSDLower limit of normalMLHFQMRCMinnesota Living with Heart Failure QuestionnaireN-terminal pro-B natriuretic peptideNSNT-pro-BNPNYHANew York Heart AssociationPCIPFTPYPrevalenceangiotensin receptor blockerangiotensin-converting enzyme inhibitoraspecific bronchial hyperreactivitybody mass indexcardiac resynchronization therapychronic obstructive pulmonary diseasecoronary artery bypass graftingcurrent smokersformer smokersheart failureimplantable cardioverter defibrillatorleft ventricular ejection fractionleft ventricular systolic dysfunctionlower limit of normalmodified Medical Research Council dyspnea scalenon-smokerspack-yearspercutaneous coronary interventionpulmonary function testsratio of forced expiratory volume in 1 s to forced vital capacity
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