To the Editor: The report of the Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) by Dr Pfisterer and colleagues1 showed similar efficacy of symptom-guided heart failure therapy compared with N-terminal brain natriuretic peptide (BNP)–guided therapy. Of 499 study participants, 104 (21%) had coexistent chronic obstructive pulmonary disease (COPD). However, the interaction between presence of COPD and mortality or hospital-free survival in this population was not described.
BNP-guided therapy with diuretics has been found to benefit patients with acute exacerbation of COPD.2 The benefit has been attributed to lower right ventricular pressure due to diuretic therapy.2 BNP is an effective screening test for the detection of cor pulmonale in patients with COPD.3
Patients with coexistent heart failure and COPD are expected to have increased right ventricular pressures, and the benefit of BNP-guided diuretic therapy or optimal heart failure therapy in this group is not known. This information is important because the prevalence of COPD in patients with heart failure is about 20% to 30%.4 Subgroup analysis is not a reliable method for arriving at conclusive observations in a randomized trial but may pave the way for further studies. Patients with heart failure and COPD often are not prescribed β-blockers due to traditional pharmacological concerns despite literature advising β-blockade in this setting.4 It would be valuable to know about the utility of β-blockers in study participants experiencing COPD.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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