Optimal Management of Heart Failure and Chronic Obstructive Pulmonary Disease: Clinical Challenges

Abstract

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common causes of breathlessness which frequently co-exist; one potentially exacerbating the other. Distinguishing between the two can be challenging due to their similar symptomatology and overlapping risk factors, but a timely and correct diagnosis is potentially lifesaving. Modern treatment for HF can substantially improve symptoms and prognosis for many patients and may have beneficial effects for patients with COPD. Conversely, while many inhaled treatments for COPD can improve symptoms and reduce exacerbations, there is conflicting evidence regarding the safety of some inhaled treatments for COPD in patients with HF. Here we explore the overlap between HF and COPD, examine the effect of one condition on the other, and address the challenges of managing patients with both conditions.

Heart failure, chronic obstructive pulmonary disease and efficacy and safety of dapagliflozin in heart failure with mildly reduced or preserved ejection fraction: Insights from DELIVER

“…The proportion of patients with an investigator-reported history of COPD in DELIVER was similar to that reported in other HFpEF trials, 1,[11][12][13] but less than in most epidemiological and registry-based studies. [4][5][6]14,15 One reason for this difference could be the exclusion of patients with severe COPD -a criterion that has been applied in recent HFpEF trials to avoid including participants with COPD misdiagnosed as HFpEF. 16,17 Another reason is likely to be the lack of systematic pulmonary function testing.…”

“…The coexistence of heart failure (HF) with a mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and chronic obstructive pulmonary disease (COPD) is common. [1][2][3][4][5][6] In addition, this comorbid intersection results in a worse prognosis than when either condition is present alone. [1][2][3][4][5][6] Therefore, there is a need for effective therapies in these high-risk individuals with both HFmrEF/HFpEF and COPD.…”

“…[1][2][3][4][5][6] In addition, this comorbid intersection results in a worse prognosis than when either condition is present alone. [1][2][3][4][5][6] Therefore, there is a need for effective therapies in these high-risk individuals with both HFmrEF/HFpEF and COPD.…”

“…The coexistence of heart failure (HF) with a mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and chronic obstructive pulmonary disease (COPD) is common 1–6 . In addition, this comorbid intersection results in a worse prognosis than when either condition is present alone 1–6 . Therefore, there is a need for effective therapies in these high‐risk individuals with both HFmrEF/HFpEF and COPD.…”

Factors associated with non-fatal heart failure and atrial fibrillation or flutter within the first 30 days post COPD exacerbation: a nested case-control study

“…Globally, the prevalence of HF in COPD is high, (10) and, of patients hospitalized for exacerbation, 20% have existing, undertreated HF (11). Incident HF attributed to exacerbations is thought to come from the increase in pulmonary arterial pressures, low blood oxygen levels (12) and activation of adrenoceptors of the autonomic nervous system. (12,13) However, shared symptomology of HF and COPD exacerbations makes new HF diagnosis difficult, with HF often missed (3,12,14) or occurring in tandem; approximately 8% of people primarily diagnosed with HF also have a secondary diagnosis of exacerbation (15).…”