Background Little is known about the impact of
chronic obstructive pulmonary disease (
COPD) in patients with
heart failure with preserved ejection fraction (HFpEF). Methods and Results We examined outcomes in patients with
heart failure with preserved ejection fraction, according to
COPD status, in the
PARAGON-HF (Prospective Comparison of
Angiotensin Receptor Neprilysin Inhibitor With
Angiotensin Receptor Blocker Global Outcomes in
Heart Failure With Preserved Ejection Fraction) trial. The primary outcome was a composite of first and recurrent hospitalizations for
heart failure and cardiovascular death. Of 4791 patients, 670 (14%) had
COPD. Patients with
COPD were more likely to be men (58% versus 47%; P<0.001) and had worse New York Heart Association functional class (class III/IV 24% versus 19%), worse Kansas City
Cardiomyopathy Questionnaire Clinical Summary Scores (69 versus 76; P<0.001) and more frequent history of
heart failure hospitalization (54% versus 47%; P<0.001). The decrement in Kansas City
Cardiomyopathy Questionnaire Clinical Summary Scores with
COPD was greater than for other common comorbidities. Patients with
COPD had echocardiographic right ventricular enlargement, higher serum
creatinine (100 μmol/L versus 96 μmol/L) and neutrophil-to-lymphocyte ratio (2.7 versus 2.5), than those without
COPD. After multivariable adjustment,
COPD was associated with worse outcomes: adjusted rate ratio for the primary outcome 1.51 (95% CI, 1.25-1.83), total
heart failure hospitalization 1.54 (95% CI, 1.24-1.90), cardiovascular death (adjusted hazard ratio [HR], 1.42; 95% CI, 1.10-1.82), and all-cause death (adjusted HR, 1.52; 95% CI, 1.25-1.84).
COPD was associated with worse outcomes than other comorbidities and Kansas City
Cardiomyopathy Questionnaire Clinical Summary Scores declined more in patients with
COPD than in those without. Conclusions Approximately 1 in 7 patients with
heart failure with preserved ejection fraction had concomitant
COPD, which was associated with greater functional limitation and a higher risk of
heart failure hospitalization and death. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.