Association Between Chronic Obstructive Pulmonary Disease Severity and Heart Failure in a Tertiary Care Cohort

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder that often coexists with cardiovascular comorbidities, particularly heart failure (HF).

To evaluate the association between the severity of COPD and the prevalence of HF in patients treated at a tertiary care hospital.

This prospective cross-sectional analytical study was conducted at Dr. Faisal Masood Teaching Hospital, Sargodha, Pakistan, from July 2024 to July 2025 on 225 patients with confirmed COPD. The severity of COPD was classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Patients were evaluated for HF through clinical examination, echocardiographic assessment, and biomarker analysis, where available.

The mean age of participants was 61.4 ± 9.7 years, with a male predominance (69.3%). Overall, 72 patients (32.0%) were diagnosed with HF. The prevalence of HF increased progressively with COPD severity: 5.9% in GOLD I, 17.7% in GOLD II, 42.7% in GOLD III, and 70.0% in GOLD IV (p < 0.001). On multivariate analysis, severe-to-very-severe COPD (OR = 5.4, 95% CI: 2.8-10.5, p < 0.001), hypertension (OR = 2.7, 95% CI: 1.4-5.3, p = 0.002), and age ≥ 60 years (OR = 1.9, 95% CI: 1.1-3.8, p = 0.04) were independent predictors of HF.

It is concluded that increasing COPD severity is significantly associated with a higher incidence of HF. Patients with advanced COPD are at greater risk of developing cardiac dysfunction due to overlapping pathophysiological mechanisms and shared risk factors.