title: Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology.
abstract: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are global epidemics incurring significant morbidity and mortality. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. Evaluation of cardiac and pulmonary function is often problematic and occasionally misleading. Echocardiography and pulmonary function tests should be performed in every patient. Careful interpretation is required to avoid misdiagnosis and inappropriate treatment. Airflow obstruction, in particular, must be demonstrated when clinically euvolaemic. Very high and very low concentrations of natriuretic peptides have high positive and negative predictive values for diagnosing HF in those with both conditions. Intermediate values are less informative. Both conditions are systemic disorders with overlapping pathophysiological processes. In patients with HF, COPD is consistently an independent predictor of death and hospitalization. However, the impact on ischaemic and arrhythmic events is unknown. Greater collaboration is required between cardiologists and pulmonologists to better identify and manage concurrent HF and COPD. The resulting symptomatic and prognostic benefits outweigh those attainable by treating either condition alone.
authors.affiliation: Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK. nathawkins@hotmail.com
authors.forename: Nathaniel Mark
authors.initials: NM
authors.lastname: Hawkins
authors.forename: Mark C
authors.initials: MC
authors.lastname: Petrie
authors.forename: Pardeep S
authors.initials: PS
authors.lastname: Jhund
authors.forename: George W
authors.initials: GW
authors.lastname: Chalmers
authors.forename: Francis G
authors.initials: FG
authors.lastname: Dunn
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology