Introduction: To investigate the impact of chronic obstructive pulmonary disease (COPD) diagnosis on one-year outcome in heart failure (HF) patients in whom sodium-glucose transport protein 2 inhibitors (SGLT2i) were initiated de novo.

Patients and Methods: Patients were recruited from a local HF registry. All patients with established HF diagnosis according to contemporary guidelines (1) in whom SGLT2i were initiated were eligible for the study. Only patients with at least 6-month follow-up were analyzed. Follow-up included either day-hospital visit or telephone interview with electronic transfer of laboratory data. Primary endpoint was composite of death and hospitalization due to acute decompensated heart failure.

Results: Out of 1191 patients included in the registry, 996 completed at least 6-month follow-up. Population was predominantly male (67.3%), aged 70 (62-76) years. In 122 (12.2%) patients a diagnosis of COPD was previously established. COPD patients had more often history of peripheral artery disease (PAD) (p=0.001), diabetes (p=0.042), New York Heart Association class III or IV ((p=0.002), presented with higher red cell distribution width (RDW) (p<0.001), and lower estimated glomerular filtration rate (p=0.024) and albumin levels (p=0.005). Death (p=0.002), HF hospitalization (p<0.001), and primary outcome (p<0.001) occurred more often in COPD patients. In Cox regression (forward conditional approach with 16 variables), COPD (Exp(B)= 2.03, 95% confidence intervals 1.33-3.12, p=0.001), along with age, log (NT-proBNP), RDW, history of stroke, and PAD predicted the occurrence of primary endpoint. At 6-month follow-up, COPD patients had higher NT-proBNP (p<0.001) and C-reactive protein (p<0.001).

Conclusion: HF diagnosis represents a high-risk feature for HF patients, not merely as a marker of more severe risk profile, but also independently being associated with worse outcome.