Chronic Obstructive Pulmonary Disease in Heart Failure: Challenges in Diagnosis and Treatment for HFpEF and HFrEF.

IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Current Heart Failure Reports Pub Date : 2024-06-01 Epub Date: 2024-03-28 DOI:10.1007/s11897-024-00660-2
Sergio Henrique Rodolpho Ramalho, André Luiz Pereira de Albuquerque
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Abstract

Purpose of review: Chronic obstructive pulmonary disease (COPD) is common in heart failure (HF), and it has a significant impact on the prognosis and quality of life of patients. Additionally, COPD is independently associated with lower adherence to first-line HF therapies. In this review, we outline the challenges of identifying and managing HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction with coexisting COPD.

Recent findings: Spirometry is necessary for COPD diagnosis and prognosis but is underused in HF. Therefore, misdiagnosis is a concern. Also, disease-modifying drugs for HF and COPD are usually safe but underprescribed when HF and COPD coexist. Patients with HF-COPD are poorly enrolled in clinical trials. Guidelines recommend that HF treatment should be offered regardless of COPD presence, but modern registries show that undertreatment persists. Treatment gaps could be attenuated by ensuring an accurate and earlier COPD diagnosis in patients with HF, clarifying the concerns related to pharmacotherapy safety, and increasing the use of non-pharmacologic treatments. Acknowledging the uncertainties, this review aims to provide key clinical resources to support better physician-patient co-decision-making and improve collaboration between health professionals.

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心衰患者的慢性阻塞性肺病:心衰患者的慢性阻塞性肺病:HFpEF 和 HFrEF 诊断和治疗的挑战》。
综述目的:慢性阻塞性肺疾病(COPD)是心力衰竭(HF)的常见病,对患者的预后和生活质量有重大影响。此外,慢性阻塞性肺病还与较低的一线心力衰竭治疗依从性有关。在这篇综述中,我们概述了识别和管理射血分数保留(HFpEF)和射血分数降低(HFrEF)的合并慢性阻塞性肺疾病的挑战:肺活量测定对慢性阻塞性肺病的诊断和预后非常必要,但在高血压中却使用不足。因此,误诊是一个令人担忧的问题。此外,治疗高血脂和慢性阻塞性肺病的改变病情药物通常是安全的,但在高血脂和慢性阻塞性肺病并存时却用药不足。高血压合并慢性阻塞性肺病患者很少参与临床试验。指南建议,无论是否存在慢性阻塞性肺病,都应提供高血压治疗,但现代登记显示,治疗不足的情况依然存在。通过确保对高血压患者进行更早和更准确的慢性阻塞性肺病诊断、澄清与药物治疗安全性相关的问题以及增加非药物治疗的使用,可以缩小治疗差距。由于存在不确定性,本综述旨在提供关键的临床资源,以支持医生与患者更好地共同决策,并改善医疗专业人员之间的合作。
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来源期刊
Current Heart Failure Reports
Current Heart Failure Reports Medicine-Emergency Medicine
CiteScore
5.30
自引率
0.00%
发文量
44
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of heart failure. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as investigative, pharmacologic, and nonpharmacologic therapies, pathophysiology, and prevention. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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