COPD Increases Risk for Heart Failure in People who Experience AMI

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People with chronic obstructive pulmonary disease (COPD) face a significantly higher risk of hospitalization from heart failure after an acute myocardial infarction (AMI), a new study has found.

The results highlight the need for careful management of these patients, both in the hospital and after discharge, according to the authors. The study was published in Archives of Medical Science Atherosclerotic Diseases.

As more and more people survive AMI, the number of patients living with heart failure has increased, wrote the study authors. Patients who experience heart failure after AMI face a worse prognosis and significantly higher mortality rates than patients without heart failure following the cardiac event. .

COPD is also associated with a higher risk of mortality and is itself a risk factor for cardiovascular disease, the authors said.

“Patients with COPD who have AMI are less aggressively treated than those without COPD, which results in increased in-hospital mortality as well as long-term mortality,” they wrote.

Previous research shows a higher risk of post–heart attack heart failure in patients with COPD, but the current investigators said most of the existing research on the matter is older, used small sample sizes, or had other significant limitations.

"There is a dearth of recent, population-level research addressing differences in heart failure hospitalizations based on COPD status among [an] all-comers cohort of AMI survivors in the United States,” they said.

To help fill the gap, the research team, led by Wilbert Aronow, MD, of the Department of Cardiology, Westchester Medical Center and New York Medical College, accessed data from the US Nationwide Readmissions Database. They identified 237 549 adults who survived an AMI between January and June of 2014. They then looked at which patients also had COPD (17.5%). These patients were more likely to be female, older, and have cardiac comorbidities, the authors said.

When the authors compared those patients with COPD to the rest of the AMI survivors, they found significant differences in outcomes. Patients with COPD had an in-hospital heart failure rate of 47.0% compared with 25.4% for patients without COPD (P<.001). Heart failure hospitalization within 6 months of an AMI was also higher in the COPD group (9.4% vs 4.6%; odds ratio [OR], 2.14; 95% CI, 2.01-2.29; P<.001). A risk-adjusted multivariate analysis erased some of that gap, but not all of it, according to the study.

“Patients with COPD had worse baseline characteristics, in-hospital outcomes, and lower revascularization rates, but the increased heart failure hospitalization risk in COPD patients persisted (although attenuated) even after adjusting for these differences,” they said.

The risk-adjusted OR of 6-month heart failure hospitalization was 1.39 (95% CI, 1.30-1.49). People with COPD were more likely to die during a heart failure hospitalization (5.7% vs 4.2% (P<.001), the authors said.

Finally, a composite outcome that combined in-hospital heart failure or 6-month heart failure hospitalization found people with COPD had a 49.0% risk compared with 26.9% in the non-COPD group (P<.001).

The authors said their results highlight the importance of improving AMI care in COPD and of early recognition of heart failure in patients with AMI.

“These findings underscore the importance of improving AMI care in patients with COPD and highlight the need for closer follow-up, careful monitoring for the development of HF, and co-management of COPD patients following an AMI to prevent the onset of HF requiring hospitalization,” they wrote.

Reference: Yandrapalli S, Pandit M, Malik A, et al. Impact of chronic obstructive pulmonary disease on heart failure hospitalizations after an acute myocardial infarction. Arch Med Sci Atheroscler Dis. Published online March 30, 2023. doi:10.5114/amsad/162014