Abstract 16514: Impact of Chronic Obstructive Pulmonary Disease on Outcomes in Heart Failure With Preserved Ejection Fraction: An Analysis of PARAGON-HF

Background: Little is known about the prognostic significance of chronic obstructive pulmonary disease (COPD) in patients with heart failure and preserved ejection fraction (HFpEF). Purpose: To evaluate the association between COPD and outcomes in the Prospective Comparison of ARNI and ARB Global Outcomes in HFpEF trial (PARAGON-HF). Methods: We assessed the relationship between the presence of COPD and the composite of time to first heart failure hospitalization or CV death, components of that composite, and all-cause death in PARAGON-HF using Cox proportional hazard models. Outcomes were adjusted for other prognostic variables including age, sex, comorbidities, LVEF, NT-proBNP and NYHA class. Results: Among 4791 participants, 670 patients (14%) had COPD. Patients with COPD were older, less likely to be female, had a worse functional class, lower LVEF, higher creatinine and markers of systemic inflammation, including neutrophil count and neutrophil/lymphocyte ratio. Compared to patients without COPD, those with COPD had a lower baseline KCCQ-CSS and were more likely to experience a clinically significant decrease in KCCQ-CSS during follow-up. COPD was associated with higher adjusted risks of the composite outcome (hazard ratio 1.50, 95%CI 1.29-1.75), heart failure hospitalization (1.54, 1.30-1.83), CV death (1.42, 1.10-1.82) and all-cause death (1.52, 1.25-1.84), all p<0.01. In comparison to the other common comorbidities, COPD was associated with the highest risk of all-cause mortality (Figure). Conclusion: In HFpEF, patients with COPD have worse functional class, quality of life and outcomes than those without COPD, and COPD is associated with a higher risk of death than other comorbidities