Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care

Abstract

Chronic obstructive pulmonary disease (COPD) is a global health issue with high social and economic costs. Concomitant chronic cardiac disorders are frequent in patients with COPD, likely owing to shared risk factors (e.g., aging, cigarette smoke, inactivity, persistent low-grade pulmonary and systemic inflammation) and add to the overall morbidity and mortality of patients with COPD. The prevalence and incidence of cardiac comorbidities are higher in patients with COPD than in matched control subjects, although estimates of prevalence vary widely. Furthermore, cardiac diseases contribute to disease severity in patients with COPD, being a common cause of hospitalization and a frequent cause of death. The differential diagnosis may be challenging, especially in older and smoking subjects complaining of unspecific symptoms, such as dyspnea and fatigue. The therapeutic management of patients with cardiac and pulmonary comorbidities may be similarly challenging: bronchodilators may have cardiac side effects, and, vice versa, some cardiac medications should be used with caution in patients with lung disease. The aim of this review is to summarize the evidence of the relationship between COPD and the three most frequent and important cardiac comorbidities in patients with COPD: ischemic heart disease, heart failure, and atrial fibrillation. We have chosen a practical approach, first summarizing relevant epidemiological and clinical data, then discussing the diagnostic and screening procedures, and finally evaluating the impact of lung-heart comorbidities on the therapeutic management of patients with COPD and heart diseases.

Chronic Respiratory Abnormalities in the Multi-Morbid Frail Elderly

“…Because of the potential adverse effect of cardiovascular drugs, and particularly the BB, the prevalence and impact of COPD has been more frequently investigated in cardiovascular diseases 33,39 .…”

“…HEART FAILURE COPD and CHF commonly coexist in clinical practice, the prevalence of COPD among HF ranging from 12 to 40% 33 . Apart from the challenging questions related to diagnosis and assessment of severity linked to overlap of common risk factors, symptoms and clinical manifestations 14,15,33 .…”

“…Apart from the challenging questions related to diagnosis and assessment of severity linked to overlap of common risk factors, symptoms and clinical manifestations 14,15,33 .…”

“…The prevalence of COPD in patients with established chronic IHD ranges from 8 to 30% 33 , and once again it is largely (> 80%) undiagnosed 42 .…”

“…The prevalence of COPD in patients with AF ranges around 10 to 15%, reaching 23.2% in patients older than 65 years and depending on the population examined (Table E3 in Roversi et al 33 ).…”