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Influence of comorbid heart disease on dyspnea and health status in patients with COPD - a cohort study
Örebro University, School of Medical Sciences. Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.ORCID iD: 0000-0001-6261-6925
Örebro University, School of Medical Sciences.ORCID iD: 0000-0003-4241-7851
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
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2018 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 13, p. 3857-3865Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to examine the changing influence over time of comorbid heart disease on symptoms and health status in patients with COPD.

Patients and methods: This is a prospective cohort study of 495 COPD patients with a baseline in 2005 and follow-up in 2012. The study population was divided into three groups: patients without heart disease (no-HD), those diagnosed with heart disease during the study period (new-HD) and those with heart disease at baseline (HD). Symptoms were measured using the mMRC. Health status was measured using the Clinical COPD Questionnaire (CCQ) and the COPD Assessment Test (CAT; only available in 2012). Logistic regression with mMRC $2 and linear regression with CCQ and CAT scores in 2012 as dependent variables were performed unadjusted, adjusted for potential confounders, and additionally adjusted for baseline mMRC, respectively, CCQ scores.

Results: Mean mMRC worsened from 2005 to 2012 as follows: for the no-HD group from 1.8 (+/- 1.3) to 2.0 (+/- 1.4), (P=0.003), for new-HD from 2.2 (+/- 1.3) to 2.4 (+/- 1.4), (P=0.16), and for HD from 2.2 (+/- 1.3) to 2.5 (+/- 1.4), (P=0.03). In logistic regression adjusted for potential confounding factors, HD (OR 1.71; 95% CI: 1.03-2.86) was associated with mMRC $ 2. Health status worsened from mean CCQ as follows: for no-HD from 1.9 (+/- 1.2) to 2.1 (+/- 1.3) with (P=0.01), for new-HD from 2.3 (+/- 1.5) to 2.6 (+/- 1.6) with (P=0.07), and for HD from 2.4 (+/- 1.1) to 2.5 (+/- 1.2) with (P=0.57). In linear regression adjusted for potential confounders, HD (regression coefficient 0.12; 95% CI: 0.04-5.91) and new-HD (0.15; 0.89-5.92) were associated with higher CAT scores. In CCQ functional state domain, new-HD (0.14; 0.18-1.16) and HD (0.12; 0.04-0.92) were associated with higher scores. After additional correction for baseline mMRC and CCQ, no statistically significant associations were found.

Conclusion: Heart disease contributes to lower health status and higher symptom burden in COPD but does not accelerate the worsening over time.
Place, publisher, year, edition, pages
DOVE Medical Press Ltd. , 2018. Vol. 13, p. 3857-3865
Keywords [en]
COPD Assessment Test, CAT, Clinical COPD Questionnaire, CCQ, modified Medical Research Council dyspnea score, mMRC, ischemic heart disease, heart failure
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:oru:diva-70781DOI: 10.2147/COPD.S175641ISI: 000452171700001Scopus ID: 2-s2.0-85058496862OAI: oai:DiVA.org:oru-70781DiVA, id: diva2:1271250
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2024-01-03Bibliographically approved
In thesis
1. Management of chronic obstructive pulmonary disease and chronic heart disease in primary health care: Guidelines, patients and comorbidity
Open this publication in new window or tab >>Management of chronic obstructive pulmonary disease and chronic heart disease in primary health care: Guidelines, patients and comorbidity
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this compilation thesis was to explore different aspects of the management of patients with chronic obstructive pulmonary disease (COPD) and heart disease in primary health care: guideline adherence in chronic heart failure (CHF) management (I); comparing patients with COPD and heart failure, and factors associated with the pa-tients’ exercise self-efficacy (II); and the influence of comorbid heart disease in COPD over time (III–IV).

Materials and methods: Cross-sectional data from primary health care: 155 patients with heart failure (I) and 150 with COPD and/or heart failure (II). Longitudinal data from patients with COPD from 2005 through 2012 (III) and 2019 (IV), based on questionnaires, medical records, and national registers.

Results: (I) Over 80% of the heart failure patients had received relevant laboratory tests and echocardiography. Recommended medication was given to most of the patients, but only a few achieved target doses. Contact with a hospital heart failure clinic was associated with better self-care behavior. (II) Patients with COPD or heart failure had similar exercise self-efficacy, symptoms, functional capacity, and health status. Exercise self-efficacy was associated with symptoms, but not with the diag-nosed disease. (III) COPD with comorbid heart disease was associated with a lower health status and higher level of dyspnea but did not accelerate the worsening over time. (IV) Comorbid heart disease was associated with increased hospitalization and mortality, not for respiratory disease, but mainly for cardiovascular and other causes.

Conclusions: Adherence to guidelines for CHF in primary health care is suboptimal, particularly regarding medication target dosage and patient education. It seems more relevant to consider the symptom level than the specific diagnosis when forming self-management groups to increase exercise self-efficacy. In COPD management in primary health care, it is important to recognize and treat heart disease.
Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 269
Keywords
COPD, chronic heart failure, heart disease, patient outcomes, exercise self-efficacy, comorbidity, primary health care, cohort study
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-101233 (URN)9789175294681 (ISBN)
Public defence
2022-11-11, Samlingssalen, Centralsjukhuset i Karlstad, Rosenborgsgatan 9, Karlstad, 13:15 (English)
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Supervisors
Available from: 2022-09-14 Created: 2022-09-14 Last updated: 2024-01-03Bibliographically approved

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Giezeman, MaaikeHasselgren, MikaelMontgomery, ScottSundh, Josefin

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