Prevalence and Factors Associated With Heart Failure among Patients with Chronic Obstructive Pulmonary Disease

Abstract

Objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) frequently coexist and share several demographic, smoking-related, and cardiometabolic characteristics. Their overlapping clinical manifestations may complicate recognition of concomitant HF, particularly in patients presenting with dyspnea and exercise intolerance. This study determined the prevalence and phenotypic distribution of HF among patients with COPD and identified factors independently associated with its presence. Methodology: This analytical cross-sectional study was conducted at Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan, from August 2025 to February 2026. A total of 383 patients aged 30–70 years with spirometry-confirmed COPD were consecutively recruited from inpatient and outpatient services of the Departments of Medicine, Pulmonology, and Cardiology. HF was assessed using predefined clinical findings, serum B-type natriuretic peptide (BNP), and echocardiographic evidence of cardiac dysfunction. HF phenotypes were classified according to left ventricular ejection fraction as HFrEF, HFmrEF, and HFpEF. Factors independently associated with HF were evaluated using multivariable binary logistic regression, with internal validation using 1,000 bootstrap resamples. Results: Among 383 participants with COPD, 180 (47.0%) had concomitant HF. Of those with HF, 73 (40.6%) had HFrEF, 34 (18.9%) had HFmrEF, and 73 (40.6%) had HFpEF. Increasing age (AOR 1.086, 95% CI 1.043–1.131; p<0.001) and cumulative smoking exposure (AOR 1.047, 95% CI 1.021–1.073; p<0.001) were independently associated with HF. Hypertension, diabetes mellitus, dyslipidaemia, ischemic heart disease, chronic kidney disease, and GOLD stage were also independently associated with HF (all p<0.05). The model demonstrated an apparent AUC of 0.931 and an optimism-corrected AUC of 0.922 following bootstrap validation. Conclusion: HF was present in nearly half of this hospital-based COPD population, with both reduced- and preserved-ejection-fraction phenotypes substantially represented. Older age, greater cumulative smoking exposure, more advanced COPD, and major cardiometabolic comorbidities were independently associated with HF. These findings support consideration of concomitant cardiac disease when evaluating selected patients with COPD, particularly those with multiple cardiovascular risk factors. Multicenter prospective studies are required to confirm these associations and determine their prognostic significance.