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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Chronic Obstructive Pulmonary Disease in Heart Failure with Reduced Ejection Fraction: Prevalence, Prognostic, and Association of Triple Inhaled Therapy

  • Nerea Aguayo-Caño1,2
  • Jesus A. Torres-Zamudio1,2
  • Jorge Perea-Armijo1,2
  • Juan D. Martin-Diaz1
  • Nouha Yacub-Briceño1
  • Manuel Cabello-Terron1
  • Enrique Enrile-Sanchez1
  • Alvaro Roldan-Guerra1,2
  • Rafael Gonzalez-Manzanares1,2,3
  • Manuel Crespin-Crespin1,2,3
  • Martin Ruiz-Ortiz1,2,3,4
  • Dolores Mesa-Rubio1,2,3
4 more authors
  • Manuel Pan-Alvarez Osorio1,2,3,5
  • Manuel Anguita-Sanchez1,2,3,5
  • Juan C. Castillo-Dominguez1,2,3
  • Jose Lopez-Aguilera1,2,3
5 affiliations
  1. 1Heart Failure Unit, Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
  2. 2Cordoba Biomedical Research Institute, IMIBIC, 14004 Cordoba, Spain
  3. 3Center for Biomedical Research Network (CIBERCV), Carlos III Health Institute, 28029 Madrid, Spain
  4. 4Faculty of Health Sciences, University of Isabel I de Castilla, 09003 Burgos, Spain
  5. 5Medicine Faculty, University of Cordoba, 14004 Cordoba, Spain
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Abstract

Background: The coexistence of heart failure with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) is a common health problem that complicates therapeutic management and worsens prognosis. Our aim was to analyse the association between COPD and HF treatment optimization, long-term clinical outcomes, mortality, and HF readmissions. Methods: A retrospective, observational study comparing two cohorts: HFrEF with COPD versus HFrEF without COPD. Beta-blocker (BB) and ivabradine dose optimization were assessed in both groups, and inhaled treatment was assessed in patients with COPD. Clinical outcomes during follow-up were analyzed using Kaplan–Meier methods and Cox proportional hazards regression. Results: 375 patients were included, of whom 71 had COPD (18.9%). No significant differences were observed between groups in BB or ivabradine dose optimization. After 60 months of follow-up, patients with COPD had higher rates of all-cause mortality (40.8% vs. 25.6%; p = 0.014), HF-related mortality (33.8% vs. 18.4%; p = 0.006), and HF readmission (50.7% vs. 35.2%; p = 0.014). COPD remained significantly associated with adverse clinical outcomes in multivariable Cox regression analysis. Among patients with COPD, dual inhaled therapy was the most common regimen (54.9%), followed by triple inhaled therapy (32.4%). Conclusions: In our cohort of patients with HFrEF, concomitant COPD was associated with higher mortality and HF readmission rates despite similar BB and ivabradine dose optimization between groups. These findings highlight the importance of COPD in the clinical management of patients with HFrEF, although the observational design of the study precludes causal conclusions. Further studies are warranted to clarify the relationship between COPD, HF outcomes, and treatment patterns.

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Cite

BibTeXRIS
BibTeX
@article{aguayocano2026chronic,
  title = {{Chronic Obstructive Pulmonary Disease in Heart Failure with Reduced Ejection Fraction: Prevalence, Prognostic, and Association of Triple Inhaled Therapy}},
  author = {Nerea Aguayo-Caño and Jesus A. Torres-Zamudio and Jorge Perea-Armijo and Juan D. Martin-Diaz and Nouha Yacub-Briceño and Manuel Cabello-Terron and Enrique Enrile-Sanchez and Alvaro Roldan-Guerra and Rafael Gonzalez-Manzanares and Manuel Crespin-Crespin and Martin Ruiz-Ortiz and Dolores Mesa-Rubio and Manuel Pan-Alvarez Osorio and Manuel Anguita-Sanchez and Juan C. Castillo-Dominguez and Jose Lopez-Aguilera},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218439},
  url = {https://www.mdpi.com/2077-0383/15/21/8439},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Chronic Obstructive Pulmonary Disease in Heart Failure with Reduced Ejection Fraction: Prevalence, Prognostic, and Association of Triple Inhaled Therapy
AU  - Nerea Aguayo-Caño
AU  - Jesus A. Torres-Zamudio
AU  - Jorge Perea-Armijo
AU  - Juan D. Martin-Diaz
AU  - Nouha Yacub-Briceño
AU  - Manuel Cabello-Terron
AU  - Enrique Enrile-Sanchez
AU  - Alvaro Roldan-Guerra
AU  - Rafael Gonzalez-Manzanares
AU  - Manuel Crespin-Crespin
AU  - Martin Ruiz-Ortiz
AU  - Dolores Mesa-Rubio
AU  - Manuel Pan-Alvarez Osorio
AU  - Manuel Anguita-Sanchez
AU  - Juan C. Castillo-Dominguez
AU  - Jose Lopez-Aguilera
PY  - 2026
DA  - 2026/10/29
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218439
UR  - https://www.mdpi.com/2077-0383/15/21/8439
AB  - Background: The coexistence of heart failure with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) is a common health problem that complicates therapeutic management and worsens prognosis. Our aim was to analyse the association between COPD and HF treatment optimization, long-term clinical outcomes, mortality, and HF readmissions. Methods: A retrospective, observational study comparing two cohorts: HFrEF with COPD versus HFrEF without COPD. Beta-blocker (BB) and ivabradine dose optimization were assessed in both groups, and inhaled treatment was assessed in patients with COPD. Clinical outcomes during follow-up were analyzed using Kaplan–Meier methods and Cox proportional hazards regression. Results: 375 patients were included, of whom 71 had COPD (18.9%). No significant differences were observed between groups in BB or ivabradine dose optimization. After 60 months of follow-up, patients with COPD had higher rates of all-cause mortality (40.8% vs. 25.6%; p = 0.014), HF-related mortality (33.8% vs. 18.4%; p = 0.006), and HF readmission (50.7% vs. 35.2%; p = 0.014). COPD remained significantly associated with adverse clinical outcomes in multivariable Cox regression analysis. Among patients with COPD, dual inhaled therapy was the most common regimen (54.9%), followed by triple inhaled therapy (32.4%). Conclusions: In our cohort of patients with HFrEF, concomitant COPD was associated with higher mortality and HF readmission rates despite similar BB and ivabradine dose optimization between groups. These findings highlight the importance of COPD in the clinical management of patients with HFrEF, although the observational design of the study precludes causal conclusions. Further studies are warranted to clarify the relationship between COPD, HF outcomes, and treatment patterns.
SN  - 2077-0383
ER  -