A Multi-Specialty Delphi Consensus on Assessing and Managing Cardiopulmonary Risk in Patients with COPD

Area of Science:

• Pulmonology
• Cardiology
• Health Services Research

Background:

• Chronic Obstructive Pulmonary Disease (COPD) poses a substantial burden in Canada, often leading to underdiagnosis and suboptimal treatment.
• Cardiovascular disease (CVD) is a frequent comorbidity in COPD patients, with significant interplay affecting mortality.
• Collaboration between respirologists and cardiologists is crucial for managing the cardiopulmonary risks in COPD.

Purpose of the Study:

• To establish consensus on optimal COPD care in Canada.
• To identify strategies for reducing cardiopulmonary risk and improving outcomes in COPD patients.
• To address the underdiagnosis and suboptimal treatment of COPD and its associated CVD.

Main Methods:

• A modified Delphi consensus involving a steering group of primary care, cardiology, and respirology experts.
• Distribution of a 4-point Likert scale questionnaire to Canadian healthcare professionals managing COPD.
• Assessment of agreement on 40 statements related to COPD and CVD management, with consensus defined as ≥75% agreement.

Main Results:

• 100 responses were received from respirologists, cardiologists, and primary care physicians.
• Very strong consensus (≥90%) was achieved on 70% of statements (28/40).
• Strong consensus (≥75%) was achieved on 17.5% of statements (7/40), with no consensus on 12.5% (5/40).

Conclusions:

• Nine key recommendations were developed based on consensus scores.
• Emphasis on comprehensive risk stratification and management to prevent COPD exacerbations.
• A call to action for implementing Canadian Thoracic Society COPD guidelines to improve patient outcomes.