Heart failure and chronic obstructive pulmonary disease: An ignored combination?
OBJECTIVE
To quantify the prevalence of heart failure and left ventricular systolic dysfunction (LVSD) in chronic obstructive pulmonary disease (COPD) patients and vice versa. Further, to discuss diagnostic and therapeutic implications of the co-existence of both syndromes.


RESULTS
We performed a Medline search from 1966 to March 2005. The reported prevalence of LVSD among COPD patients varied considerably, with the highest prevalence (10-46%) among those with an exacerbation. One single study assessed the prevalence of heart failure in COPD patients. A prevalence of 21% of previously unknown heart failure was reported in patients with a history of COPD or asthma. We did not find any report on COPD in heart failure or LVSD patients. Diagnosing heart failure in COPD patients or vice versa is complicated by overlap in signs and symptoms, and diminished diagnostic value of additional investigations. In general, pulmonary and heart failure 'drug cocktails' can be administered safely to patients with concomitant COPD and heart failure, although (short acting) beta2-adrenoreceptor agonists and digitalis have potentially deleterious effects on cardiac and pulmonary function, respectively.


CONCLUSIONS
Although knowledge about the prevalence of concomitant heart failure in COPD patients and vice versa is scarce, it seems that the combined presence is rather common. In view of diagnostic and therapeutic implications, more attention should be paid to the concomitant presence of both syndromes in clinical practice and research.
Utrecht Heart Failure Organisation (UHFO), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85060, Stratenum 6.101, 3508 AB Utrecht, the Netherlands. F.H.Rutten@umcutrecht.nl
Frans H
FH
Rutten
Maarten-Jan M
MJ
Cramer
Jan-Willem J
JW
Lammers
Diederick E
DE
Grobbee
Arno W
AW
Hoes
D000318:Adrenergic beta-Agonists / Q000009:adverse effects; D000368:Aged; D015897:Comorbidity; D004070:Digitalis / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy
D000318:Adrenergic beta-Agonists