Current challenges in managing comorbid heart failure and COPD

ABSTRACT

Introduction: Heart failure (HF) with reduced ejection fraction and chronic obstructive pulmonary disease (COPD) frequently coexist, particularly in the elderly. Given their rising prevalence and the contemporary trend to longer life expectancy, overlapping HF–COPD will become a major cause of morbidity and mortality in the next decade.

Areas covered: Drawing on current clinical and physiological constructs, the consequences of negative cardiopulmonary interactions on the interpretation of pulmonary function and cardiopulmonary exercise tests in HF–COPD are discussed. Although those interactions may create challenges for the diagnosis and assessment of disease stability, they provide a valuable conceptual framework to rationalize HF–COPD treatment. The impact of COPD or HF on the pharmacological treatment of HF or COPD, respectively, is then comprehensively discussed. Authors finalize by outlining how the non-pharmacological treatment (i.e. rehabilitation and exercise reconditioning) can be tailored to the specific needs of patients with HF–COPD.

Expert commentary: Randomized clinical trials testing the efficacy and safety of new medications for HF or COPD should include a sizeable fraction of patients with these coexistent pathologies. Multidisciplinary clinics involving cardiologists and respirologists trained in both diseases (with access to unified cardiorespiratory rehabilitation programs) are paramount to decrease the humanitarian and social burden of HF–COPD.

KEYWORDS:

• Heart failure
• COPD
• cardiopulmonary interaction
• cardiac function
• lung function
• cardiopulmonary exercise testing

Declaration of interest

JA Neder has received research funding via Queen’s University from Boehringer Ingelheim and has served on speakers’ bureaus, consultation panels, and advisory boards for AstraZeneca, Boehringer Ingelheim, and Chiesi Pharmaceutici. DE O’Donnell reports receiving grants during the conduct of the study from the following industry partners: Boehringer Ingelheim Canada Ltd, AstraZeneca Canada Inc. and Novartis Canada Ltd. DE O’Donnell also reports receiving grants and personal fees from the following: GSK, Boehringer Ingelheim, and AstraZeneca. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.