Alvaro Roldan-Guerra

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.

Background: Patients with heart failure and reduced ejection fraction (HFrEF) who achieve improved ejection fraction (HFimpEF) after guideline-directed medical therapy exhibit superior prognosis. However, functional impairment remains a hallmark of HF. Aims: To characterize and compare exercise capacity profiles via cardiopulmonary exercise testing (CPET) between patients with HFimpEF and those with persistently reduced ejection fraction (HFprEF) using a baseline-adjusted analysis. Methods: Data from a longitudinal cohort of 111 HFrEF patients with baseline and follow-up CPET data (minimum 6-month follow-up) were analyzed. Patients were stratified into HFimpEF and HFprEF groups, according to the Universal Definition of HF. Changes between groups were evaluated using Analysis of Covariance (ANCOVA) adjusted for baseline values, with non-parametric Bootstrapping (2000 resamples) and multiplicity. Results: We included 111 patients: 69 with HFimpEF (62.2%) and 42 with HFprEF (37.8%). At a median follow-up of 8.7 months, the HFimpEF group showed significantly greater reverse remodeling (adjusted ΔLVEF +19.9%, p < 0.001) and a greater reduction in NT-proBNP levels (−557.6 pg/mL, p = 0.042). Both groups demonstrated intra-group functional improvements. However, in adjusted between-group ANCOVA models, HFimpEF achieved a significantly greater recovery in percentage of predicted peak oxygen consumption (adjusted difference: +8.5%; 95% CI: 1.2 to 16.1; p = 0.021). Net adjusted between-group differences for absolute VO₂peak gain, submaximal threshold, ventilatory efficiency and recovery kinetics did not reach statistical significance. Multivariate analysis identified older age (beta −0.261, p = 0.010), diabetes mellitus (beta −0.210, p = 0.023) and baseline VO₂peak (beta −0.569, p < 0.001) as negative predictors of improvement. Conclusions: Comprehensive HFrEF management improves exercise capacity across all patients. Although HFimpEF yields superior gains in normalized aerobic capacity, overall functional trajectories are largely comparable between phenotypes. This structural-functional decoupling underscores persistent residual limitations in HFimpEF, supporting CPET for longitudinal risk stratification.

Introduction: Abnormal serum potassium levels are a common issue in patients with heart failure with reduced ejection fraction (HFrEF), limiting the use of prognostically beneficial therapies. The primary aim of this study was to characterise the HFrEF population according to baseline potassium levels and to assess their impact on medium- to long-term prognosis. Methods: A retrospective study was conducted on a cohort of consecutive patients with HFrEF recruited at our centre. Patients were classified according to baseline serum potassium levels into: Group 1 (5.0 mEq/L). Prognostic impact was assessed in terms of HF readmissions, HF mortality and all-cause mortality. Results: A total of 409 patients were analysed. The median age was 69 years [IQR 59–77], with a predominance of male patients (74.1%). There were 26 patients (6.36%) with hypokalaemia, 365 (89.24%) with normokalaemia, and 18 (4.4%) with hyperkalaemia. Group 1 showed a higher prevalence of diabetes mellitus (69.2% vs. 47.4% vs. 33.4%; p = 0.043) and a greater proportion of patients with ≥2 previous admissions for HF (25% vs. 10.5% vs. 0%; p = 0.008). No differences were observed regarding echocardiographic parameters, markers of congestion, or HFrEF treatment. After a median follow-up of 60 months, no significant differences were found between groups in rates of HF readmissions, HF mortality and all-cause mortality. Conclusions: Patients with hypokalaemia exhibited a higher prevalence of diabetes mellitus and previous HF admissions. In our population, no differences were observed between groups in the use of prognostically beneficial therapies or in outcomes in terms of HF rehospitalisations and mortality.

Background: Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main objective was to analyse the clinical profile according to the number of previous admissions for HF and its prognostic impact in the medium and long term. Methods: A retrospective study of a cohort of patients with HFrEF, classified according to previous admissions: cohort-1 (0–1 previous admission) and cohort-2 (≥2 previous admissions). Clinical, echocardiographic and therapeutic variables were analysed, and the medium- and long-term impacts in terms of hospital readmissions and cardiovascular mortality were assessed. A total of 406 patients were analysed. Results: The mean age was 67.3 ± 12.6 years, with male predominance (73.9%). Some 88.9% (361 patients) were included in cohort-1, and 45 patients (11.1%) were included in cohort-2. Cohort-2 had a higher proportion of atrial fibrillation (49.9% vs. 73.3%; p = 0.003), chronic kidney disease (36.3% vs. 82.2%; p < 0.001), and anaemia (28.8% vs. 53.3%; p = 0.001). Despite having similar baseline ventricular structural parameters, cohort-1 showed better reverse remodelling. With a median follow-up of 60 months, cohort-1 had longer survival free of hospital readmissions for HF (37.5% vs. 92%; p < 0.001) and cardiovascular mortality (26.2% vs. 71.9%; p < 0.001), with differences from the first month. Conclusions: Patients with HFrEF and ≥2 previous admissions for HF have a higher proportion of comorbidities. These patients are associated with worse reverse remodelling and worse medium- and long-term prognoses from the early stages, wherein early identification is essential for close follow-up and optimal intensive treatment.