Coexisting Chronic Obstructive Pulmonary Disease and Heart Failure: Implications for Treatment, Course and Mortality

Joana Mascarenhas; Ana Azevedo; Paulo Bettencourt

Disclosures

Curr Opin Pulm Med. 2010;16(2):106-111. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Chronic obstructive pulmonary disease (COPD) and heart failure are prevalent comorbidities affecting a huge proportion of the world population, responsible for significant morbidity and mortality. Their coexistence is more frequent than previously recognized and poses important diagnostic and therapeutic challenges. Prognosis of patients with concurrent heart failure and COPD has not been comprehensively addressed. With this review, we intend to emphasize the diagnosis and prognosis implications of the two coexisting conditions and to highlight the therapeutic constraints posed by the combination.
Recent findings: Progressively, more attention has been given to the interplay between COPD and heart failure. The combination is frequent, but largely unrecognized due to overlapping clinical manifestations. Patients presenting with both conditions seem to have an ominous course. Despite the overwhelming evidence supporting cardioselective β-blockade safety and tolerability in COPD patients, β-blockers are underprescribed to heart failure patients with concomitant COPD.
Summary: COPD and heart failure coexistence is often overlooked. COPD diagnosis can remain unsuspected in heart failure patients due to similar symptoms. Although β-blockers are well tolerated in COPD patients, they are overall less prescribed in this challenging population. COPD, at least at severe degrees of airflow obstruction, predicts a worse prognosis in heart failure patients.

Introduction

Heart failure and chronic obstructive pulmonary disease (COPD) are major public health epidemics, with increasing prevalence.[1,2••,3••] Although both conditions have been extensively studied separately, clinicians often fail to recognize one syndrome in the presence of the other, mainly due to the similarities in clinical presentation and additionally due to scarcity of reports specifically addressing the combination.[4] According to available evidence, COPD and heart failure often coexist, and the prevalence of the combination is variable, depending on the population studied (community, outpatient or hospitalized) and on the diagnostic criteria applied.[4,5••] The coexistence of the two conditions is further supported by shared risk factors, notably age and smoking.[1,5••,6]

Since the publication of several trials demonstrating the efficacy and the survival benefits of β-blockers, these agents are considered the cornerstone of systolic heart failure management.[7–9] Although extensive evidence concerning safety of selective β-1 blockade in respiratory disease has accumulated,[10,11] COPD is commonly advocated as the principal cause for nonadherence to heart failure therapeutic guidelines because it is generally perceived as a contraindication to β-blockers use.[12,13] Indeed, patients with coexisting heart failure and COPD are often deprived of the long-term benefits of this intervention.[12,14] Apart from these therapeutic issues, the prognosis of patients with concomitant heart failure and COPD is not completely understood. In an increasing number of studies,[15•,16•,17] COPD has been found to adversely impact on prognosis of heart failure patients, being an independent predictor of mortality and hospitalization.

The present review focuses on the therapeutic dilemmas and prognostic impact of coexisting COPD and heart failure and outlines the diagnostic challenges presented by the combination. The prevalence of the two coexisting syndromes will be addressed briefly.

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