{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T17:13:41Z","timestamp":1769361221493,"version":"3.49.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T00:00:00Z","timestamp":1633478400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Heart failure with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) individually cause significant morbidity and mortality. Their coexistence is associated with even worse outcomes, partly due to suboptimal heart failure therapy, especially underutilisation of beta\u2010blockers. Our aim was to investigate outcomes in HFrEF patients with and without COPD, and the effects of mineralocorticoid receptor antagonists (MRAs) on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      We studied the effect of MRA therapy in a post\u2010hoc pooled analysis of 4397 HFrEF patients in the RALES and EMPHASIS\u2010HF trials. The primary endpoint was the composite of heart failure hospitalisation or cardiovascular death. A total of 625 (14.2%) of the 4397 patients had COPD. Patients with COPD were older, more often male, and smokers, but less frequently treated with a beta\u2010blocker. In patients with COPD, event rates (per 100 person\u2010years) for the primary endpoint and for all\u2010cause mortality were 25.2 (95% confidence interval 22.1\u201328.7) and 17.2 (14.9\u201319.9), respectively, compared with 19.9 (18.8\u201321.1) and 12.8 (12.0\u201313.7) in participants without COPD. The risks of all\u2010cause hospitalisation and sudden death were also higher in patients with COPD. The benefit of MRA, compared with placebo, was consistent in patients with or without COPD for all outcomes, e.g. hazard ratio for the primary outcome 0.66 (0.50\u20130.85) for COPD and 0.65 (0.58\u20130.73) for no COPD (interaction\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.93). MRA\u2010induced hyperkalaemia was less frequent in patients with COPD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In RALES and EMPHASIS\u2010HF, one\u2010in\u2010seven patients with HFrEF had coexisting COPD. HFrEF patients with COPD had worse outcomes than those without. The benefits of MRAs were consistent, regardless of COPD status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2350","type":"journal-article","created":{"date-parts":[[2021,9,18]],"date-time":"2021-09-18T09:14:57Z","timestamp":1631956497000},"page":"529-538","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Effects of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction patients with chronic obstructive pulmonary disease in\n                    <scp>EMPHASIS\u2010HF<\/scp>\n                    and\n                    <scp>RALES<\/scp>"],"prefix":"10.1093","volume":"24","author":[{"given":"Su E.","family":"Yeoh","sequence":"first","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pooja","family":"Dewan","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Serenelli","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"},{"name":"Cardiovascular Centre of Ferrara University Ferrara University  Ferrara Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Pedro","family":"Ferreira","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"},{"name":"National Institute of Health and Medical Research Center for Clinical Multidisciplinary Research, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy French Clinical Research Infrastructure Network Investigation Network Initiative \u2010 Cardiovascular and Renal Clinical Trialists  Nancy 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