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Original Research |

The Impact of Ischemic Heart Disease on Symptoms, Health Status, and Exacerbations in Patients With COPDImpact of Ischemic Heart Disease on COPD

Anant R. C. Patel, MBBS; Gavin C. Donaldson, PhD; Alex J. Mackay, MBBS; Jadwiga A. Wedzicha, MD; John R. Hurst, PhD
Author and Funding Information

From the Academic Unit of Respiratory Medicine, University College London Medical School, London, England.

Correspondence to: Anant R. C. Patel, MBBS, Academic Unit of Respiratory Medicine, University College London Medical School, Royal Free Campus, Rowland Hill St, London, NW3 2PF, England; e-mail: anant.patel@ucl.ac.uk


For editorial comment see page 837

Funding/Support: Dr Patel is funded by a Medical Research Council Clinical Research Training Fellowship. The London COPD cohort is funded by the Medical Research Council Patient Research Cohort Initiative.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):851-857. doi:10.1378/chest.11-0853
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Background:  Comorbid ischemic heart disease (IHD) is a common and important cause of morbidity and mortality in patients with COPD. The impact of IHD on COPD in terms of a patient’s health status, exercise capacity, and symptoms is not well understood.

Methods:  We analyzed stable-state data of 386 patients from the London COPD cohort between 1995 and 2009 and prospectively collected exacerbation data in those who had completed symptom diaries for ≥ 1 year.

Results:  Sixty-four patients (16.6%) with IHD had significantly worse health status as measured by the St. George Respiratory Questionnaire (56.9 ± 18.5 vs 49.1 ± 19.0, P = .003), and a larger proportion of this group reported more severe breathlessness in the stable state, with a Medical Research Council dyspnea score of ≥ 4 (50.9% vs 35.1%, P = .029). In subsets of the sample, stable patients with COPD with IHD had a higher median (interquartile range [IQR]) serum N-terminal pro-brain natriuretic peptide concentration than those without IHD (38 [15, 107] pg/mL vs 12 [6, 21] pg/mL, P = .004) and a lower exercise capacity (6-min walk distance, 225 ± 89 m vs 317 ± 85 m; P = .002). COPD exacerbations were not more frequent in patients with IHD (median, 1.95 [IQR, 1.20, 3.12] vs 1.86 (IQR, 0.75, 3.96) per year; P = .294), but the median symptom recovery time was 5 days longer (17.0 [IQR, 9.8, 24.2] vs 12.0 [IQR, 8.0, 18.0]; P = .009), resulting in significantly more days per year reporting exacerbation symptoms (median, 35.4 [IQR, 13.4, 60.7] vs 22.2 [IQR, 5.7, 42.6]; P = .028). These findings were replicated in multivariate analyses allowing for age, sex, FEV1, and exacerbation frequency where applicable.

Conclusions:  Comorbid IHD is associated with worse health status, lower exercise capacity, and more dyspnea in stable patients with COPD as well as with longer exacerbations but not with an increased exacerbation frequency.

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