Der Klinikarzt 2019; 48(10): 420-427
DOI: 10.1055/a-1014-9860
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Herzinsuffizienz, COPD und Betablocker-Therapie

Herausforderungen der kardialen und pulmonalen Komorbiditäten
Mathias M. Borst
1   Caritas-Krankenhaus Bad Mergentheim
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
21. Oktober 2019 (online)

ZUSAMMENFASSUNG

Herzinsuffizienz und COPD sind häufig und begegnen uns vielfach gemeinsam. Jede der beiden Erkrankungen führt als Komorbidität der anderen zu einer erhöhten Morbidität und Mortalität, was eine erhöhte Aufmerksamkeit erfordert. Dies gilt in der stabilen Phase und besonders während akuter Dekompensation bzw. Exazerbation. Eine exakte Diagnostik ist notwendig. Sie sollte bei Patienten mit COPD neben klinischen Parametern EKG, Echokardiografie und die Bestimmung eines natriuretischen Peptids umfassen, bei solchen mit Herzinsuffizienz zumindest eine Spirometrie. COPD und Herzinsuffizienz werden jeweils ohne Abstriche leitliniengerecht behandelt. Eine Therapie mit kardioselektiven Betablockern aus kardiologischer Indikation darf COPD-Patienten nicht verweigert werden, wie es vielfach der Fall ist. Vielmehr verbessert sie deren Prognose signifikant.

 
  • Literatur

  • 1 Greulich T, Weist BJD, Koczulla AR. et al Prevalence of comorbidities in COPD patients by disease severity in a German population. Respir Med 2017; 132: 132-138
  • 2 Roversi S, Fabbri LM, Sin DD. et al Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care. Am J Respir Crit Care Med 2016; 194: 1319-1336
  • 3 Carter P, Lagan J, Fortune C. et al Association of Cardiovascular Disease With Respiratory Disease. J Am Coll Cardiol 2019; 73: 2166-2177
  • 4 Chen W, Thomas J, Sadatsafavi M. et al Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med 2015; 3: 631-639
  • 5 Boudestein LC, Rutten FH, Cramer MJ. et al The impact of concurrent heart failure on prognosis in patients with chronic obstructive pulmonary disease. Eur J Heart Fail 2009; 11: 1182-1188
  • 6 Sin DD, Anthonisen NR, Soriano JB. et al Mortality in COPD: Role of comorbidities. Eur Respir J 2006; 28: 1245-1257
  • 7 Mannino DM, Thorn D, Swensen A. et al Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008; 32: 962-969
  • 8 Wedzicha JA, Brill SE, Allinson JP. et al Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease. BMC Med 2013; 11: 181
  • 9 Hawkins NM, Petrie MC, Jhund PS. et al Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 2009; 11: 130-139
  • 10 Kwon BJ, Kim DB, Jang SW. et al Prognosis of heart failure patients with reduced and preserved ejection fraction and coexistent chronic obstructive pulmonary disease. Eur J Heart Fail 2010; 12: 1339-1344
  • 11 Mentz RJ, Schulte PJ, Fleg JL. et al Clinical characteristics, response to exercise training, and outcomes in patients with heart failure and chronic obstructive pulmonary disease: findings from Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION). Am Heart J 2013; 165: 193-199
  • 12 Buddeke J, Bots ML, van Dis I. et al Trends in comorbidity in patients hospitalised for cardiovascular disease. Int J Cardiol 2017; 248: 382-388
  • 13 Buddeke J, Bots ML, van Dis I. et al Comorbidity in patients with cardiovascular disease in primary care: a cohort study with routine healthcare data. Br J Gen Pract 2019; 69: e398-e406
  • 14 Guder G, Brenner S, Stork S. et al Chronic obstructive pulmonary disease in heart failure: accurate diagnosis and treatment. Eur J Heart Fail 2014; 16: 1273-1282
  • 15 Iversen KK, Kjaergaard J, Akkan D. et al Chronic obstructive pulmonary disease in patients admitted with heart failure. J Intern Med 2008; 264: 361-369
  • 16 Rushton CA, Satchithananda DK, Jones PW. et al Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis. Int J Cardiol 2015; 196: 98-106
  • 17 Fisher KA, Stefan MS, Darling C. et al Impact of COPD on the mortality and treatment of patients hospitalized with acute decompensated heart failure: the Worcester Heart Failure Study. Chest 2015; 147: 637-645
  • 18 Scrutinio D, Guida P, Passantino A. et al Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival. Eur J Intern Med 2019; 60: 31-38
  • 19 Tockman MS, Comstock GW. Respiratory risk factors and mortality: longitudinal studies in Washington County, Maryland. Am Rev Respir Dis 1989; 140: S56-S63
  • 20 Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 2003; 107: 1514-1519
  • 21 Vanfleteren LE, Spruit MA, Groenen M. et al Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 187: 728-735
  • 22 Alter P, Watz H, Kahnert K. et al Airway obstruction and lung hyperinflation in COPD are linked to an impaired left ventricular diastolic filling. Respir Med 2018; 137: 14-22
  • 23 Hohlfeld JM, Vogel-Claussen J, Biller H. et al Effect of lung deflation with indacaterol plus glycopyrronium on ventricular filling in patients with hyperinflation and COPD (CLAIM): a double-blind, randomised, crossover, placebo-controlled, single-centre trial. Lancet Respir Med 2018; 6: 368-378
  • 24 Canepa M, Straburzynska-Migaj E, Drozdz J. et al Characteristics, treatments and 1-year prognosis of hospitalized and ambulatory heart failure patients with chronic obstructive pulmonary disease in the European Society of Cardiology Heart Failure Long-Term Registry. Eur J Heart Fail 2018; 20: 100-110
  • 25 De Blois J, Simard S, Atar D. et al COPD predicts mortality in HF: the Norwegian Heart Failure Registry. J Card Fail 2010; 16: 225-229
  • 26 Guazzi M, Myers J, Vicenzi M. et al Cardiopulmonary exercise testing characteristics in heart failure patients with and without concomitant chronic obstructive pulmonary disease. Am Heart J 2010; 160: 900-905
  • 27 Gerges M, Gerges C, Pistritto AM. et al Pulmonary Hypertension in Heart Failure. Epidemiology, Right Ventricular Function, and Survival. Am J Respir Crit Care Med 2015; 192: 1234-1246
  • 28 Gulea C, Zakeri R, Quint JK. Impact of chronic obstructive pulmonary disease on readmission after hospitalization for acute heart failure: A nationally representative US cohort study. Int J Cardiol 2019; 290: 113-118
  • 29 MacDonald MI, Shafuddin E, King PT. et al Cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease. Lancet Respir Med 2016; 4: 138-148
  • 30 Vogelmeier CF, Criner GJ, Martinez FJ. et al Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Eur Respir J 2017: 49
  • 31 Vogelmeier C, Buhl R, Burghuber O. et al Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). Pneumologie 2018; 72: 253-308
  • 32 Pirina P, Martinetti M, Spada C. et al Prevalence and management of COPD and heart failure comorbidity in the general practitioner setting. Respir Med 2017; 131: 1-5
  • 33 Ponikowski P, Voors AA, Anker SD. et al 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129-2200
  • 34 Rutten FH, Moons KG, Cramer MJ. et al Recognising heart failure in elderly patients with stable chronic obstructive pulmonary disease in primary care: cross sectional diagnostic study. Bmj 2005; 331: 1379
  • 35 Pavasini R, Tavazzi G, Biscaglia S. et al Amino terminal pro brain natriuretic peptide predicts all-cause mortality in patients with chronic obstructive pulmonary disease: Systematic review and meta-analysis. Chron Respir Dis 2017; 14: 117-126
  • 36 Lipworth B, Wedzicha J, Devereux G. et al Beta-blockers in COPD: time for reappraisal. Eur Respir J 2016; 48: 880-888
  • 37 Hawkins NM, Jhund PS, Simpson CR. et al Primary care burden and treatment of patients with heart failure and chronic obstructive pulmonary disease in Scotland. Eur J Heart Fail 2010; 12: 17-24
  • 38 Roberts E, Ludman AJ, Dworzynski K. et al The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. Bmj 2015; 350: h910
  • 39 Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J 2016; 37: 2097-2104
  • 40 Triest FJ, Franssen FM, Spruit MA. et al Poor agreement between chart-based and objectively identified comorbidities of COPD. Eur Respir J 2015; 46: 1492-1495
  • 41 Bundesärztekammer (BÄK), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Kassenärztliche Bundesvereinigung (KBV). Nationale VersorgungsLeitlinie Chronische Herzinsuffizienz – Langfassung, Version 3 [im Druck]
  • 42 Kovacs G, Dumitrescu D, Barner A. et al Definition, clinical classification and initial diagnosis of pulmonary hypertension: Updated recommendations from the Cologne Consensus Conference 2018. Int J Cardiol 2018; 272 s 11-19
  • 43 Olschewski H, Behr J, Bremer H. et al Pulmonary hypertension due to lung diseases: Updated recommendations from the Cologne Consensus Conference 2018. Int J Cardiol 2018; 272 s 63-68
  • 44 Weitzenblum E. Chronic cor pulmonale. Heart 2003; 89: 225-230
  • 45 Rosenkranz S, Lang IM, Blindt R. et al Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018. International Journal of Cardiology 2018; 272: 53-62
  • 46 Ghio S, Gavazzi A, Campana C. et al Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol 2001; 37: 183-188
  • 47 Andersson C, Hansen PW, Steffensen IE. et al Mortality associated with cardiovascular drugs in patients with chronic obstructive pulmonary disease and right-sided heart failure – A danish nationwide registry-based study. Eur J Intern Med 2019; 63: 56-61
  • 48 Borst MM, Beuthien W, Schwencke C. et al Desensitization of the pulmonary adenylyl cyclase system: A cause of airway hyperresponsiveness in congestive heart failure?. Journal of the American College of Cardiology 1999; 34: 848-856
  • 49 Salpeter SR, Ormiston TM, Salpeter EE. Cardioselective beta-blockers in patients with reactive airway disease: a meta-analysis. Ann Intern Med 2002; 137: 715-725
  • 50 Quint JK, Herrett E, Bhaskaran K. et al Effect of beta blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records. Bmj 2013; 347: f6650
  • 51 Coiro S, Girerd N, Rossignol P. et al Association of beta-blocker treatment with mortality following myocardial infarction in patients with chronic obstructive pulmonary disease and heart failure or left ventricular dysfunction: a propensity matched-cohort analysis from the High-Risk Myocardial Infarction Database Initiative. Eur J Heart Fail 2017; 19: 271-279
  • 52 Short PM, Lipworth SI, Elder DH. et al Effect of beta blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study. BMJ 2011; 342: d2549
  • 53 Du Q, Sun Y, Ding N. et al Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD: a meta-analysis of observational studies. PLoS One 2014; 9: e113048
  • 54 Nielsen AO, Pedersen L, Sode BF. et al beta-Blocker Therapy and Risk of Chronic Obstructive Pulmonary Disease – A Danish Nationwide Study of 1.3 Million Individuals. EClinicalMedicine 2019; 7: 21-26
  • 55 Lim KP, Loughrey S, Musk M. et al Beta-blocker under-use in COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12: 3041-3046
  • 56 Loop MS, van Dyke MK, Chen L. et al Low Utilization of Beta-Blockers Among Medicare Beneficiaries Hospitalized for Heart Failure With Reduced Ejection Fraction. J Card Fail 2019; 25: 343-351
  • 57 Kratzer L, Noakes P, Baumwol J. et al Under-utilisation of beta-blockers in patients with acute coronary syndrome and comorbid chronic obstructive pulmonary disease. Intern Med J 2018; 48: 931-936
  • 58 Lipworth B, Skinner D, Devereux G. et al Underuse of beta-blockers in heart failure and chronic obstructive pulmonary disease. Heart 2016; 102: 1909-1914
  • 59 Corrao S, Brunori G, Lupo U. et al Effectiveness and safety of concurrent beta-blockers and inhaled bronchodilators in COPD with cardiovascular comorbidities. Eur Respir Rev 2017: 26
  • 60 Maltais F, Buhl R, Koch A. et al beta-Blockers in COPD: A Cohort Study From the TONADO Research Program. Chest 2018; 153: 1315-1325
  • 61 Rutten FH, Zuithoff NP, Hak E. et al Beta-blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease. Arch Intern Med 2010; 170: 880-887
  • 62 Huang YL, Lai CC, Wang YH. et al Impact of selective and nonselective beta-blockers on the risk of severe exacerbations in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12: 2987-2996
  • 63 Mersfelder TL, Shiltz DL. beta-Blockers and the Rate of Chronic Obstructive Pulmonary Disease Exacerbations. Ann Pharmacother 2019; 53: 1249-1258
  • 64 Global Initiative for Asthma Global Strategy for Asthma Management and Prevention. 2018
  • 65 Sessa M, Mascolo A, Scavone C. et al Comparison of Long-Term Clinical Implications of Beta-Blockade in Patients With Obstructive Airway Diseases Exposed to Beta-Blockers With Different beta1-Adrenoreceptor Selectivity: An Italian Population-Based Cohort Study. Front Pharmacol 2018; 9: 1212
  • 66 Lainscak M, Podbregar M, Kovacic D. et al Differences between bisoprolol and carvedilol in patients with chronic heart failure and chronic obstructive pulmonary disease: a randomized trial. Respir Med 2011; 105 (Suppl. 01) S44-S49