Psychosocial distress in heart failure with asthma and chronic obstructive pulmonary disease

Investigations on the combination of the comorbidities heart failure (HF), asthma/chronic obstructive pulmonary disease (COPD), and psychosocial distress (PSD) differentiated by asthma/COPD and HF type or severity are scarce.

To investigate the impact of PSD on prognosis in HF patients with comorbid asthma/COPD depending on the HF severity.

A secondary analysis of the prospective observational cohort RECODE-HF study.

Kaplan-Meier curves (log-rank tests) illustrate the time to the composite endpoint (12-month hospitalization or death) in the asthma/COPD-PSD subgroups within each NYHA functional class. Prognostic analyses include multivariable Cox proportional hazards regression (n=2499) including potential confounding conditions.

In total, 780 endpoints occurred (649 hospitalizations;131 deaths). Kaplan-Meier analysis revealed a significant reduction in estimated mean time to composite endpoint: -31 days (hazard ratio, HR 1.901;CI95% 1.325-2.674) in asthma/COPD/PSD+NYHA II; -47 days (HR 1.981;CI95% 1.364-2.879) and -40 days (HR 1.867;CI95% 1.361-2.561) in asthma/COPD/PSD+and no-asthma-or-COPD/PSD+in NYHA III; -93 days in no-asthma-or-COPD/PSD+NYHA IV (HR 2.457;CI95% 1.015-5.945) (reference no-asthma-or-COPD/PSD-; NYHA I). Cox regression showed a significant global three-way interaction regarding hospitalization or death between NYHA class, asthma/COPD, PSD (P=0.037), and a 10.06-fold hazard (CI95% 1.118-90.498) regarding the NYHA class II subgroup*asthma/COPD*PSD (P=0.039).

Comorbidity of HF, asthma/COPD and PSD showed an impact on prognosis by the NYHA functional class. Future research needs to investigate the special needs of patients with PSD and asthma/COPD with focus on those in NYHA class II. PSD screening seems relevant to identify patients with especially poor prognosis.