Author + information
- Received January 17, 2019
- Revision received April 26, 2019
- Accepted May 11, 2019
- Published online September 30, 2019.
- Marco Canepa, MD, PhDa,b,∗∗ (, )
- Frits M.E. Franssen, MD, PhDc,d,∗,
- Horst Olschewski, MDe,
- Mitja Lainscak, MD, PhDf,
- Michael Böhm, MDg,
- Luigi Tavazzi, MDh and
- Stephan Rosenkranz, MD, PhDi,j
- aCardiovascular Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- bIRCCS Ospedale Policlinico San Martino, Genoa, Italy
- cCIRO, Horn, the Netherlands
- dDepartment of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- eMedical University of Graz, Department of Internal Medicine, Division of Pulmonology, Graz, Austria
- fFaculty of Medicine, University of Ljubljana and Department of Internal Medicine, General Hospital Murska Sobota, Ljubljana, Slovenia
- gSaarland University Medical Center, Homburg, Germany
- hMaria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- iClinic III for Internal Medicine (Cardiology) and Center for Molecular Medicine, University of Cologne, Cologne, Germany
- jCologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
- ↵∗Address for correspondence:
Dr. Marco Canepa, Cardiovascular Unit, Department of Internal Medicine, University of Genoa, 16126 Genoa, Italy OR Dr. Marco Canepa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
• Spirometry and beta-blockers are underused in patients with HF with known or suspected COPD.
• Bronchial obstruction should always be confirmed using spirometry and patients sent to pulmonology consultation.
• Bronchodilators and beta-blockers are initiated on the basis of the severity of each condition and adequately titrated thereafter.
• These medications should be adjusted during hospitalizations, avoiding unnecessary withdrawals.
• Patients with HF would definitely benefit from greater integration between cardiology and pulmonology.
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) coincide in a significant number of patients. Recent population-based registries suggest that spirometry is largely underused in patients with HF to diagnose comorbid COPD and that patients with COPD frequently do not receive the recommended beta-blocker (BB) treatment. This state-of-the-art review summarizes: 1) current challenges in the implementation of recommended spirometry for COPD diagnosis in patients with HF; and 2) current underuse and underdosing of BBs in patients with HF and COPD despite guideline recommendations. Open issues in the therapeutic management of patients with HF and COPD are discussed in the third section, including the use of the nonselective BB carvedilol, target BB doses in patients with HF and COPD, BB and bronchodilator management during HF hospitalization with and without COPD exacerbation, and the use of BBs in patients with COPD with right HF or free from cardiovascular disease. The whole scenario described herein advocates for a bipartisan initiative to drive immediate attention to the translation of guideline recommendations into clinical practice for patients with HF with co-occurring COPD.
↵∗ Drs. Canepa and Franssen contributed equally to this work.
Dr. Canepa has received personal fees for lectures and consultancies from Novartis, Pfizer, and Vifor. Dr. Franssen has received personal fees for lectures and consultancies from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Teva, and Verona Pharma; and has received research funding from Novartis and MedImmune. Dr. Tavazzi has received personal fees from Servier (as a trial committee member and member of the Speakers Bureau) and CVIE Therapeutics (as a trial committee member). Dr. Böhm has received personal fees from Amgen, Bayer, Servier, Medtronic, Boehringer Ingelheim, Vifor, and Bristol-Myers Squibb. Dr. Rosenkranz has received personal fees for lectures and consultancies from Abbot, Actelion, Arena, Bayer, Gilead, GlaxoSmithKline, Merck, Novartis, Pfizer, and United Therapeutics; and has received research grants to his institution from Actelion, Bayer, Novartis, Pfizer, and United Therapeutics. Dr. Olschewski has received personal fees for lectures and consultancies from Actelion, Bayer, Boehringer, Bristol-Myers Squibb, Chiesi, GlaxoSmithKline, Inventiva, Menarini, Merck Sharpe & Dohme, Novartis, Pfizer, and Roche. Dr. Lainscak has received personal fees for lectures and consultancies from AstraZeneca, Boehringer Ingelheim, Novartis, Pfizer, and Vifor; and has received research funding from Roche Diagnostics. All fees reported were outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 17, 2019.
- Revision received April 26, 2019.
- Accepted May 11, 2019.
- 2019 American College of Cardiology Foundation
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