In a single-center study of smokers with heart failure, those who also had emphysema identified by CT were twice as likely to be rehospitalized for heart failure in the following two years. In addition, they demonstrated 70 percent greater odds of dying during that time frame than smokers without emphysema.
“These data should serve as the basis for further study including considering whether therapy based on the presence of emphysema on CT can improve complex HF outcomes,” lead author Puja Kohli, MD, with Massachusetts General Hospital in Boston, and colleagues wrote in PLOS One. “Specifically, future studies should consider whether initiation of anti-muscarinics, beta-agonists or inhaled steroids based on the presence of emphysema on chest CT can improve complex HF outcomes.”
The researchers identified 225 inpatients who both smoked and had heart failure from January through March of 2014. The study population was 69 years old on average, 69 percent male and had an average left ventricular ejection fraction (LVEF) of 46 percent.
Forty-six percent of those patients had emphysema upon CT. After adjusting for other risk factors, they were 2.11 times more likely to be readmitted for heart failure over a 2.1-year follow-up and 70 percent more likely to die.
Kohli et al. said the poor outcomes may be partially explained by the increased left ventricular afterload noted in the emphysema group.
“Our study findings add to that data and show an association between emphysema by CT and an increased cardiac afterload specifically among patients with HF,” they wrote. “The mechanism by which afterload is increased in patients with emphysema and HF is unclear; however, data suggest that increased transmural pressure due to thoracic pressure swings, extrinsic compression in the setting of hyperinflation, and systemic inflammation may all play a role.”
In addition to being more likely to wind up back in the hospital, emphysema patients also averaged longer stays (seven days versus five) and were likely to be readmitted sooner—a median 162 days versus 327 days for people without emphysema.
Kohli and colleagues noted that almost half of the patients in their study had emphysema, including 39 percent without known chronic obstructive pulmonary disorder.
“This under-recognized group of patients with both emphysema and heart failure may benefit from improved recognition and characterization of their co-morbid disease processes and optimization of therapies for their lung disease,” the authors wrote.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.