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Chronic Obstructive Pulmonary Disease in Heart Failure: Challenges in Diagnosis and Treatment for HFpEF and HFrEF

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Abstract

Purpose of Review

Chronic obstructive pulmonary disease (COPD) is common in heart failure (HF), and it has a significant impact on the prognosis and quality of life of patients. Additionally, COPD is independently associated with lower adherence to first-line HF therapies. In this review, we outline the challenges of identifying and managing HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction with coexisting COPD.

Recent Findings

Spirometry is necessary for COPD diagnosis and prognosis but is underused in HF. Therefore, misdiagnosis is a concern. Also, disease-modifying drugs for HF and COPD are usually safe but underprescribed when HF and COPD coexist.

Summary

Patients with HF-COPD are poorly enrolled in clinical trials. Guidelines recommend that HF treatment should be offered regardless of COPD presence, but modern registries show that undertreatment persists. Treatment gaps could be attenuated by ensuring an accurate and earlier COPD diagnosis in patients with HF, clarifying the concerns related to pharmacotherapy safety, and increasing the use of non-pharmacologic treatments. Acknowledging the uncertainties, this review aims to provide key clinical resources to support better physician-patient co-decision-making and improve collaboration between health professionals.

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Abbreviations

COPD:

Chronic obstructive pulmonary disease

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with preserved ejection fraction

QoL:

Quality of life

HF-COPD:

Coexistence of HF and COPD

FEV1 :

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

GOLD:

Global Initiative for Chronic Obstructive Lung Disease

ATS:

American Thoracic Society

ERS:

European Respiratory Society

KCCQ-TSS:

Kansas City Cardiomyopathy Questionnaire—Total Symptom Score

KCCQ-CSS:

Kansas City Cardiomyopathy Questionnaire—Clinical Symptom Score

DLCO:

Diffusing capacity of lung for carbon monoxide

TLC:

Total lung capacity

FOT:

The forced oscillation technique

ACE:

Angiotensin converting enzyme

ARB:

Angiotensin receptor blocker

ARNi:

Angiotensin receptor/neprilysin inhibitor

MRA:

Mineralocorticoid receptor antagonists

LABA:

Long acting beta-agonists

LAMA:

Long acting muscarinic antagonists

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Authors and Affiliations

  1. Clinical Research Center, Hospital Brasília/DASA, Brasília, DF, Brazil

    Sergio Henrique Rodolpho Ramalho

  2. School of Medicine, UniCeub, Centro Universitário de Brasília, Brasília, DF, Brazil

    Sergio Henrique Rodolpho Ramalho

  3. Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    André Luiz Pereira de Albuquerque

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Ramalho, S.H.R., de Albuquerque, A.L.P. Chronic Obstructive Pulmonary Disease in Heart Failure: Challenges in Diagnosis and Treatment for HFpEF and HFrEF. Curr Heart Fail Rep (2024). https://doi.org/10.1007/s11897-024-00660-2

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