High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

Jönsson, Andreas; Fedorowski, Artur; Engström, Gunnar; Wollmer, Per; Hamrefors, Viktor

doi:10.1136/openhrt-2018-000848

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…Patients may not be motivated to seek medical help due to a lack of understanding of the disease itself, feelings of guilt and stigma associated with a COPD diagnosis, 101 , 102 the feeling that it is “too late” to change or simply due to ignoring symptoms and/or attributing them to another cause. 103 , 104 Greater public awareness and knowledge of the condition and the possibilities for its treatment are needed to counter these issues. Implementing behavior-targeted interventions with the aim of improving physical activity should also be considered as physical activity is often significantly reduced in COPD patients.…”

Section: Resultsmentioning

confidence: 99%

CONQUEST Quality Standards: For the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of COPD Care

Pullen¹,

Miravitlles²,

Sharma³

et al. 2021

COPD

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Background Chronic obstructive pulmonary disease (COPD) are managed predominantly in primary care. However, key opportunities to optimize treatment are often not realized due to unrecognized disease and delayed implementation of appropriate interventions for both diagnosed and undiagnosed individuals. The COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) is the first-of-its-kind, collaborative, interventional COPD registry. It comprises an integrated quality improvement program focusing on patients (diagnosed and undiagnosed) at a modifiable and higher risk of COPD exacerbations. The first step in CONQUEST was the development of quality standards (QS). The QS will be imbedded in routine primary and secondary care, and are designed to drive patient-centered, targeted, risk-based assessment and management optimization. Our aim is to provide an overview of the CONQUEST QS, including how they were developed, as well as the rationale for, and evidence to support, their inclusion in healthcare systems. Methods The QS were developed (between November 2019 and December 2020) by the CONQUEST Global Steering Committee, including 11 internationally recognized experts with a specialty and research focus in COPD. The process included an extensive literature review, generation of QS draft wording, three iterative rounds of review, and consensus. Results Four QS were developed: 1) identification of COPD target population, 2) assessment of disease and quantification of future risk, 3) non-pharmacological and pharmacological intervention, and 4) appropriate follow-up. Each QS is followed by a rationale statement and a summary of current guidelines and research evidence relating to the standard and its components. Conclusion The CONQUEST QS represent an important step in our aim to improve care for patients with COPD in primary and secondary care. They will help to transform the patient journey, by encouraging early intervention to identify, assess, optimally manage and followup COPD patients with modifiable high risk of future exacerbations.

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Section: Resultsmentioning

confidence: 99%

CONQUEST Quality Standards: For the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of COPD Care

Pullen¹,

Miravitlles²,

Sharma³

et al. 2021

COPD

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“…Myocardial perfusion imaging (MPI) was performed and interpreted according to current guidelines [ 43 , 44 ] as a part of routine clinical investigation at the Department of Clinical Physiology and Nuclear Medicine at Skåne University Hospital in Malmö, Sweden. The MPI protocol, which has been previously described in detail [ 42 ], included provocation with either exercise on a bicycle or pharmacological provocation with adenosine or regadenosone, after which 99m Tc-tetrofosmin was injected, and Single Photon Emission Computed Tomography (SPECT) Images were obtained using a dual-head gamma camera (Siemens AG Medical Solutions, Erlangen, Germany). From March 2015 the SPECT acquisition was complemented by a low dose CT scan for attenuation correction.…”

Section: Methodsmentioning

confidence: 99%

“…The BiG CaPPS cohort. Data were collected from the Biomarkers and Genetics Cardio-Pulmonary Physiology Study (BiG CaPPS)-cohort, which has been previously described in detail [42]. In short, the BiG CaPPS cohort consists of 500 outpatients with suspected stable myocardial ischemia, all of whom had been clinically referred by a physician to myocardial perfusion imaging (MPI) during 2014-2017.…”

Section: Study Populationmentioning

confidence: 99%

Common physiologic and proteomic biomarkers in pulmonary and coronary artery disease

et al. 2022

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Objective Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. There is a well-known comorbidity between COPD and CAD, which is only partly explained by smoking and other known common risk factors. In order to better understand the relationship between COPD and CAD, we analyzed myocardial perfusion, pulmonary function and novel cardiovascular biomarkers in patients with symptoms suggesting myocardial ischemia. Methods A total of 396 subjects from the Swedish Biomarkers and Genetics CardioPulmonary Physiology Study (BiG CaPPS) were included, all of whom had been referred to myocardial perfusion imaging due to suspected myocardial ischemia. Subjects performed myocardial perfusion imaging (MPI), pulmonary function tests (PFT) and analysis of 92 proteomic biomarkers, previously associated with cardiovascular disease. Linear regression was used to study the relationship between MPI and PFT results and proteomic biomarkers. Results Subjects with CAD (n = 159) had lower diffusing capacity (DLCO) than patients without CAD (6.64 versus 7.17 mmol/(min*kPa*l); p = 0.004) in models adjusted for common covariates such as smoking, but also diabetes and brain natriuretic peptide (BNP). The association remained significant after additional adjustment for forced expiratory volume in one second (FEV1) (p = 0.009). Subjects with CAD, compared with subjects without CAD, had higher total airway resistance (0.37 vs 0.36 kPa/(l/s); p = 0.036). Among 92 protein biomarkers, nine were associated with a combined diagnosis of CAD and airflow obstruction: VSIG2, KIM1, FGF-23, REN, XCL1, GIF, ADM, TRAIL-R2 and PRSS8. Significance Diffusing capacity for carbon monoxide is decreased in patients with CAD, independently of decreased FEV1, diabetes, and elevated BNP. Several cardiovascular biomarkers are associated with co-existent CAD and airflow obstruction, but none with airflow obstruction only. The current findings indicate that the interaction between CAD and lung function is complex, including mechanisms beyond the known association between CAD and reduced ventilation.

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“…16,25 This association has been explained by common risk factors, most notably smoking. 25,26 We also found that in the PiZZ individuals, COPD was an independent risk factor for developing IHD both in PiZZ subjects and in controls. However, smoking was an independent risk factor for developing IHD only in the controls, not in the PiZZ subjects, which is difficult to explain.…”

Section: Discussionmentioning

confidence: 54%

<p>Decreased Risk of Ischemic Heart Disease in Individuals with Severe Alpha 1-Antitrypsin Deficiency (PiZZ) in Comparison with the General Population</p>

Tanash¹,

Ekström²,

Basil³

et al. 2020

COPD

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Background: Severe alpha-1-antitrypsin deficiency (AATD) is an established risk factor for chronic obstructive pulmonary disease (COPD) and liver disease, but the effect on the incidence of ischemic heart disease (IHD) is not well known. The aim was to evaluate the risk of incident IHD in patients with severe AATD compared with a random sample of the general population, with known smoking habits. Methods: AAT-deficient individuals, phenotype PiZZ (n=1545), were included in the Swedish National AATD Register. Controls (n=5883) were selected from population-based cohorts in Northern Sweden. Data on IHD and comorbidities were obtained by nationwide cross-linkage with the Swedish National Patient Register. Risk factors for incident IHD were analyzed using Cox regression, adjusted for age, gender, smoking status and the presence of COPD, hypertension, hyperlipidemia and diabetes. Results: At inclusion, 46% of the PiZZ individuals and 53% of the controls were neversmokers. During follow-up (median 16 years; range 0.2-23), 8% (n=123) of PiZZ individuals and 12% (n=690) of controls developed IHD. The controls had a significantly higher risk for incident IHD than the PiZZ individuals, with adjusted hazard ratio (HR) of 1.8 (95% CI 1.4-2.3). The risk was higher for controls in both ever-smokers (HR 2.1; 95% CI 1.5-2.9) and never-smokers (HR 1.5; 95% CI 1.1-2.2). Conclusion: PiZZ individuals have a lower risk of developing incident ischemic heart disease than the control subjects with known smoking habits, who had been randomly selected from population-based cohorts.

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High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

Cited by 6 publications

References 29 publications

CONQUEST Quality Standards: For the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of COPD Care

CONQUEST Quality Standards: For the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of COPD Care

Common physiologic and proteomic biomarkers in pulmonary and coronary artery disease

<p>Decreased Risk of Ischemic Heart Disease in Individuals with Severe Alpha 1-Antitrypsin Deficiency (PiZZ) in Comparison with the General Population</p>

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