{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T11:21:44Z","timestamp":1793532104502,"version":"4.5.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,2,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Chronic obstructive pulmonary disease (COPD) is a common comorbidity in heart failure with reduced ejection fraction, associated with undertreatment and worse outcomes. New treatments for heart failure with reduced ejection fraction may be particularly important in patients with concomitant COPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We examined outcomes in 8399 patients with heart failure with reduced ejection fraction, according to COPD status, in the PARADIGM\u2010HF (Prospective Comparison of Angiotensin Receptor Blocker\u2013Neprilysin Inhibitor With Angiotensin\u2010Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial. Cox regression models were used to compare COPD versus non\u2010COPD subgroups and the effects of sacubitril\/valsartan versus enalapril. Patients with COPD (n=1080, 12.9%) were older than patients without COPD (mean 67 versus 63\u00a0years;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), with similar left ventricular ejection fraction (29.9% versus 29.4%), but higher NT\u2010proBNP (N\u2010terminal pro\u2010B\u2010type natriuretic peptide; median, 1741\u00a0pg\/mL versus 1591\u00a0pg\/mL; P=0.01), worse functional class (New York Heart Association III\/IV 37% versus 23%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) and Kansas City Cardiomyopathy Questionnaire\u2013Clinical Summary Score (73 versus 81;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), and more congestion and comorbidity. Medical therapy was similar in patients with and without COPD except for beta\u2010blockade (87% versus 94%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) and diuretics (85% versus 80%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). After multivariable adjustment, COPD was associated with higher risks of heart failure hospitalization (hazard ratio [HR], 1.32; 95% CI, 1.13\u20131.54), and the composite of cardiovascular death or heart failure hospitalization (HR, 1.18; 95% CI, 1.05\u20131.34), but not cardiovascular death (HR, 1.10; 95% CI, 0.94\u20131.30), or all\u2010cause mortality (HR, 1.14; 95% CI, 0.99\u20131.31). COPD was also associated with higher risk of all cardiovascular hospitalization (HR, 1.17; 95% CI, 1.05\u20131.31) and noncardiovascular hospitalization (HR, 1.45; 95% CI, 1.29\u20131.64). The benefit of sacubitril\/valsartan over enalapril was consistent in patients with and without COPD for all end points.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In PARADIGM\u2010HF, COPD was associated with lower use of beta\u2010blockers and worse health status and was an independent predictor of cardiovascular and noncardiovascular hospitalization. Sacubitril\/valsartan was beneficial in this high\u2010risk subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT01035255.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.120.019238","type":"journal-article","created":{"date-parts":[[2021,1,30]],"date-time":"2021-01-30T05:25:27Z","timestamp":1611984327000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":51,"title":["Clinical Characteristics and Outcomes of Patients With Heart Failure With Reduced Ejection Fraction and Chronic Obstructive Pulmonary Disease: Insights From PARADIGM\u2010HF"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5826-4696","authenticated-orcid":false,"given":"Solmaz","family":"Ehteshami\u2010Afshar","sequence":"first","affiliation":[{"name":"Department of Medicine Yale University School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne","family":"Mooney","sequence":"additional","affiliation":[{"name":"BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Dewan","sequence":"additional","affiliation":[{"name":"BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay S.","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Brigham and Women\u2019s Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8441-6887","authenticated-orcid":false,"given":"Ninian N.","family":"Lang","sequence":"additional","affiliation":[{"name":"BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin P.","family":"Lefkowitz","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceutical Corporation East Hanover NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6333-9496","authenticated-orcid":false,"given":"Mark C.","family":"Petrie","sequence":"additional","affiliation":[{"name":"BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel R.","family":"Rizkala","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceutical Corporation East Hanover NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean L.","family":"Rouleau","sequence":"additional","affiliation":[{"name":"Institut de Cardiologie Universit\u00e9 de Montr\u00e9al Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3698-9597","authenticated-orcid":false,"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Brigham and Women\u2019s Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6358-2154","authenticated-orcid":false,"given":"Karl","family":"Swedberg","sequence":"additional","affiliation":[{"name":"University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor C.","family":"Shi","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceutical Corporation East Hanover NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7076-221X","authenticated-orcid":false,"given":"Michael R.","family":"Zile","sequence":"additional","affiliation":[{"name":"Department of Medicine Medical University of South Carolina Charleston SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1828-2387","authenticated-orcid":false,"given":"Milton","family":"Packer","sequence":"additional","affiliation":[{"name":"Baylor Heart and Vascular InstituteBaylor University Medical CenterImperial College Dallas TX USA"},{"name":"Imperial College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-3975","authenticated-orcid":false,"given":"John J. 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