Differences in Outcomes between Heart Failure Phenotypes in Patients with Coexistent Chronic Obstructive Pulmonary Disease A Cohort Study

Rationale: Differences in clinical presentation and outcomes between heart failure (HF) phenotypes in patients with chronic obstructive pulmonary disease (COPD) have not been assessed. Objectives: The aim of this study was to compare clinical outcomes and healthcare resource use between patients with COPD and HF with preserved ejection fraction (HFpEF), mildly reduced ejection fraction (HFmEF), and reduced ejection fraction (HFrEF). Methods: Patients with COPD and HF were identified in the U.S. administrative claims database OptumLabs DataWarehouse between 2008 and 2018. All-cause and cause-specific (HF) hospitalization, acute exacerbation of COPD (AECOPD, severe and moderate combined), mortality, and healthcare resource use were compared between HF phenotypes. Results: From 5,419 patients with COPD, 70% had HFpEF, 20% had HFrEF, and 10% had HFmEF. All-cause hospitalization did not differ across groups; however, patients with COPD and HFrEF had a greater risk of HF-specific hospitalization (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.29-1.84) and mortality (HR, 1.17; 95% CI, 1.03-1.33) than patients with COPD and HFpEF. Conversely, patients with COPD and HFrEF had a lower risk of AECOPD than those with COPD and HFpEF (HR, 0.75; 95% CI, 0.66-0.87). Rates of long-term stays (in skilled-nursing facilities) and emergency room visits were lower for those with COPD and HFrEF than for those with COPD and HFpEF. Conclusions: Outcomes in patients with comorbid COPD and HFpEF are largely driven by COPD. Given the paucity in treatments for HFpEF, better differentiation between cardiac and respiratory symptoms may provide an opportunity to reduce the risk of AECOPD. Risk of death and HF hospitalization were highest among patients with COPD and HFrEF, emphasizing the importance of optimizing guideline-recommended HFrEF therapies in this group.