Personalizing the approach for the diagnosis of patients with concomitant Chronic Obstructive Pulmonary Disease and...

Chronic Obstructive Pulmonary Disease (COPD) and Heart failure (HF) are often concomitant, they are overlooked in practice. The objectives of this study were to determine the prevalence of HF in diagnosed COPD and COPD in diagnosed HF from a specialized clinics and determine patients' characteristics which could be used to in clinical practice for active screening. We conducted a prospective cohort study in a specialized COPD clinic and HF clinic. Patients underwent detailed cardiopulmonary evaluation to establish diagnosis and were followed for 12 months. The prevalence of unrecognized COPD and HF were respectively 26.1 % and 26.8 %, and these patients were older, more likely to be male and heavy smokers. COPD patients with abnormal vs those with normal echocardiography had an increased rate of mod-severe exacerbation like events (1.3 vs 0.6). They also had a higher prevalence of self-reported heart disease, diabetes, abnormal ECG, cardiovascular medication use, higher blood eosinophil and troponin but no difference on lung function, computed tomography-assessed emphysema and gas trapping, symptom burden and health status. HF patients with abnormal vs those with normal spirometry had increased exacerbation like-events (16.7 % vs 6.3 % but reach statistical significance). They also had more heart disease, worse lung function by definition and gas trapping, higher blood eosinophil but no difference in symptom burden and health status. In two specialized clinics the prevalence of concomitant disease -undiagnosed HF in COPD patients and undiagnosed COPD in HF patients was common. Distinctive features were limited to clinical characteristics, but specific biomarkers cannot be recommended.