https://doi.org/10.4081/monaldi.2025.3157
Chronic obstructive pulmonary disease and heart failure in real life: the tip of the iceberg in the sea of comorbidities. A prospective observational study
Submitted: July 29, 2024
Accepted: December 11, 2024
Published: February 4, 2025
Accepted: December 11, 2024
Abstract Views: 4
PDF_EARLY VIEW: 1
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are two of the most common conditions treated in internal medicine. Although it is known that these diseases often coexist, the specific characteristics of the affected patients and the prognostic implications are not yet well understood. Managing patients with both COPD and HF requires an integrated treatment approach. The aim of the study was to examine the association between COPD and HF. We conducted a prospective observational cohort study. All consenting patients admitted to the Internal Medicine Department from the Emergency Department with known or strongly suspected COPD were enrolled. A total of 144 patients were included, with 47.2% of them also having HF, distributed among the various HF subcategories as follows: 10.4% with HF with reduced ejection fraction (HFrEF), 3.5% with HF with mild-reduced ejection fraction, and 33.3% with HF with preserved ejection fraction (HFpEF). This result is consistent with the literature, which suggests a higher prevalence of COPD in patients with HFpEF compared to HFrEF. A Doppler echocardiography was performed during hospitalization. Some variables showed a statistically significant difference when comparing patients with COPD and HF to those with COPD without HF. Interestingly, the follow-up at 3 and 6 months post-discharge revealed higher mortality in patients with HF, with an odds ratio (95% confidence interval) of 10.0 (1.2-82.2). This study could contribute to a better understanding of the prognostic implications arising from the coexistence of COPD and HF, emphasizing the importance of a patient-centered approach in managing multiple comorbidities.
Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. J Glob Health 2015;5:020415.
DOI: https://doi.org/10.7189/jogh.05.020415
Ntritsos G, Franek J, Belbasis L, et al. Gender-specific estimates of COPD prevalence: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2018;13:1507-14.
DOI: https://doi.org/10.2147/COPD.S146390
GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385:117-71.
DOI: https://doi.org/10.1016/S0140-6736(14)61682-2
Shahim B, Kapelios CJ, Savarese G, Lund LH. Global public health burden of heart failure: an updated review. Card Fail Rev 2023;9:e11.
DOI: https://doi.org/10.15420/cfr.2023.05
Naeije R. Pulmonary hypertension and right heart failure in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2005;2:20-2.
DOI: https://doi.org/10.1513/pats.200407-037MS
McCullough PA, Hollander JE, Nowak RM, et al. Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department. Acad Emerg Med 2003;10:198-204.
DOI: https://doi.org/10.1111/j.1553-2712.2003.tb01990.x
Rutten FH, Cramer M-JM, Grobbee DE, et al. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J 2005;26:1887-94.
DOI: https://doi.org/10.1093/eurheartj/ehi291
Bernabeu-Wittel M, Para O, Voicehovska J, et al. Competences of internal medicine specialists for the management of patients with multimorbidity. EFIM multimorbidity working group position paper. Eur J Intern Med 2023;109:97-106.
DOI: https://doi.org/10.1016/j.ejim.2023.01.011
Kotlyarov S. Analysis of the comorbid course of chronic obstructive pulmonary disease. J Pers Med 2023;13:1179.
DOI: https://doi.org/10.3390/jpm13071179
Fabbri LM, Celli BR, Agustí A, et al. COPD and multimorbidity: recognising and addressing a syndemic occurrence. Lancet Respir Med 2023;11:1020-34.
DOI: https://doi.org/10.1016/S2213-2600(23)00261-8
Sin DD. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005;2:8-11.
DOI: https://doi.org/10.1513/pats.200404-032MS
Güder G, Störk S. COPD and heart failure: differential diagnosis and comorbidity. Herz 2019;44:502-8.
DOI: https://doi.org/10.1007/s00059-019-4814-7
De Miguel-Díez J, Chancafe Morgan J, Jimenez-Garcia R. The association between COPD and heart failure risk: a review. Int Chron Obstruct Pulmon Dis 2013;305-12.
DOI: https://doi.org/10.2147/COPD.S31236
Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 1989;42:703-9.
DOI: https://doi.org/10.1016/0895-4356(89)90065-6
McDonagh TA, Metra M, Adamo M, et al. 2023 Focused update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. G Ital Cardiol 2024;25:202-13. [Article in Italian].
DOI: https://doi.org/10.15829/1560-4071-2023-5168
National Cancer Institute. Definition of pack year. 2011. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pack-year.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83.
DOI: https://doi.org/10.1016/0021-9681(87)90171-8
GOLD. 2023 GOLD report. Global Initiative for Chronic Obstructive Lung Disease - GOLD. Available from: https://goldcopd.org/2023-gold-report-2/.
Chiumeo F, Folloni S. Chronic obstructive pulmonary disease and heart failure: research and clinical practice in primary care. Ital J Med 2015;9:346-8.
DOI: https://doi.org/10.4081/itjm.2015.560
Nozzoli C, Anastasio L, Fabbri LM, et al. Complexity of patients with chronic obstructive pulmonary disease hospitalized in internal medicine: a survey by FADOI. Ital J Med 2015;9:120-4.
DOI: https://doi.org/10.4081/itjm.2015.516
Hawkins NM, Petrie MC, Jhund PS, et al. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 2009;11:130-9.
DOI: https://doi.org/10.1093/eurjhf/hfn013
Mentz RJ, Kelly JP, Von Lueder TG, et al. Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol 2014;64:2281-93.
DOI: https://doi.org/10.1016/j.jacc.2014.08.036
Ather S, Chan W, Bozkurt B, et al. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol 2012;59:998-1005.
DOI: https://doi.org/10.1016/j.jacc.2011.11.040
Beghé B, Verduri A, Roca M, Fabbri LM. Exacerbation of respiratory symptoms in COPD patients may not be exacerbations of COPD. Eur Respir J 2013;41:993-5.
DOI: https://doi.org/10.1183/09031936.00180812
Aisanov Z, Khaltaev N. Management of cardiovascular comorbidities in chronic obstructive pulmonary disease patients. J Thorac Dis 2020;12:2791-802.
DOI: https://doi.org/10.21037/jtd.2020.03.60
Redfield MM, Borlaug BA. Heart failure with preserved ejection fraction: a review. JAMA 2023;329:827-38.
DOI: https://doi.org/10.1001/jama.2023.2020
Chirinos JA. Exercise training in heart failure with preserved ejection fraction: is the peripheral vasculature involved? JACC Heart Fail 2023;11:465-8.
DOI: https://doi.org/10.1016/j.jchf.2023.01.022
Rucker D, Joseph J. Defining the phenotypes for heart failure with preserved ejection fraction. Curr Heart Fail Rep 2022;19:445-57.
DOI: https://doi.org/10.1007/s11897-022-00582-x
Vaduganathan M, Docherty KF, Claggett BL, et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomized controlled trials. Lancet 2022;400:757-67.
DOI: https://doi.org/10.1016/S0140-6736(22)01429-5
Labaki WW, Xia M, Murray S, et al. NT-proBNP in stable COPD and future exacerbation risk: Analysis of the SPIROMICS cohort. Respir Med 2018;140:87-93.
DOI: https://doi.org/10.1016/j.rmed.2018.06.005
Ozaki AF, Ko DT, Chong A, et al. Prescribing patterns and factors associated with sodium-glucose cotransporter-2 inhibitor prescribing in patients with diabetes mellitus and atherosclerotic cardiovascular disease. CMAJ Open 2023;11:E494-503.
DOI: https://doi.org/10.9778/cmajo.20220039
Andrijevic I, Milutinov S, Lozanov Crvenkovic Z, et al. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as a diagnostic biomarker of left ventricular systolic dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Lung 2018;196:583-90.
DOI: https://doi.org/10.1007/s00408-018-0137-3
Schneider A, Gantner L, Maag I, et al. Are ICD-10 codes appropriate for performance assessment in asthma and COPD in general practice? Results of a cross sectional observational study. BMC Health Serv Res 2005;5:11.
DOI: https://doi.org/10.1186/1472-6963-5-11
d’Avila Melo SM, de Oliveira LA, Wanderley JLF, Rocha RDA. Evaluating the extremely elderly at a pulmonary function clinic for the diagnosis of respiratory disease: frequency and technical quality of spirometry. J Bras Pneumol 2019;45:e20180232.
DOI: https://doi.org/10.1590/1806-3713/e20180232
Chukowry PS, Spittle DA, Turner AM. Small airways disease, biomarkers and COPD: where are we? Int J Chron Obstruct Pulmon Dis 2021;16:351-65.
DOI: https://doi.org/10.2147/COPD.S280157
Rahman HH, Rashid MH, Miah NA, et al. Correlation study between COPD and heart failure in elderly patient. Mymensingh Med J 2022;31:498-505.
Hannink JD, van Helvoort HA, Dekhuijzen PN, Heijdra YF. Heart failure and COPD: partners in crime? Respirology 2010;15:895-901.
DOI: https://doi.org/10.1111/j.1440-1843.2010.01776.x
Ventrella F, Mastroianni F, Errico M. Chronic obstructive pulmonary disease pathways as a tool to improve appropriateness in internal medicine departments. Ital J Med 2015;9:96-108.
DOI: https://doi.org/10.4081/itjm.2014.448
López-Pardo ME, Candal-Pedreira C, Valdés-Cuadrado L, et al. Factors related with hospital attendance and mortality in patients with COPD: a case-control study in a real-life setting. Int J Chron Obstruct Pulmon Dis 2022;17:809-19.
DOI: https://doi.org/10.2147/COPD.S355236
Pezzuto A, Ricci A, D'Ascanio M, et al. Short-term benefits of smoking cessation improve respiratory function and metabolism in smokers. Int J Chron Obstruct Pulmon Dis 2023;18:2861-5.
DOI: https://doi.org/10.2147/COPD.S423148
Ethics Approval
The study was performed in accordance with the Declaration of Helsinki and local regulations. The study was approved by local ethical committee (n. 24860_oss).How to Cite
Para, Ombretta, Marco Vanetti, Chiara Dibonaventura, Davide Salerno, Lorenzo Caruso, Christian Carleo, Asim Raza, Carlo Nozzoli, and Antonio Spanevello. 2025. “Chronic Obstructive Pulmonary Disease and Heart Failure in Real Life: The Tip of the Iceberg in the Sea of Comorbidities. A Prospective Observational Study”. Monaldi Archives for Chest Disease, February. https://doi.org/10.4081/monaldi.2025.3157.
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Berardo Sarubbi, Giancarlo Scognamiglio, Flavia Fusco, Enrico Melillo, Michele D'Alto, Maria Giovanna Russo, A “long-standing†malpositioned pacing lead. Long-term follow-up after extraction , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Ahmed Ghanaym, Khaled Elkhashab, Gomaa AbdelRazek, Eman Mahmoud, Evaluation of left atrial dysfunction by speckle tracking echocardiography in systolic and diastolic heart failure , Monaldi Archives for Chest Disease: Vol. 92 No. 4 (2022)
- G. Caramori, G. Bettoncelli, R. Tosatto, F. Arpinelli, G. Visonà , G. Invernizzi, B.F. Novelletto, A. Papi, I.M. Adcock, A. Ciaccia, Underuse of spirometry by general practitioners for the diagnosis of COPD in Italy , Monaldi Archives for Chest Disease: Vol. 63 No. 1 (2005): Pulmonary series
- Mahmood Shirzad, Abbasali Karimi, Seyed Hossein Ahmadi, Mehrab Marzban, Mokhtar Tazik, Hermineh Aramin, Predictors and Early Outcome of Prolonged Mechanical Ventilation in Contemporary Heart valve Surgery , Monaldi Archives for Chest Disease: Vol. 74 No. 1 (2010): Cardiac series
- G. Caramori, M. Fabbri, D. Paioli, F. Falcone, C. Severino, G. Felisatti, O. Arar, I.M. Adcock, K. Fan Chung, P.J. Barnes, A. Ciaccia, A. Papi, Asthma is not a common cause of severe chronic respiratory failure in non-smokers: ALOT study , Monaldi Archives for Chest Disease: Vol. 63 No. 2 (2005): Pulmonary series
- Raffaele Griffo, Antonio Spanevello, Pier Luigi Temporelli, Pompilio Faggiano, Mauro Carone, Giovanna Magni, Nicolino Ambrosino, Luigi Tavazzi, Italian survey on prevalence and disease management of chronic heart failure and chronic obstructive pulmonary disease comorbidity in ambulatory patients. SUSPIRIUM study rationale and design , Monaldi Archives for Chest Disease: Vol. 82 No. 1 (2014): Cardiac series
- Marinella Sommaruga, Elisabetta Angelino, Paola Della Porta, Mara Abatello, Giacomo Baiardo, Gianluigi Balestroni, Ornella Bettinardi, Edward Callus, Chiara Ciracì, Ombretta Omodeo, Claudia Rizza, Paolo Michielin, Marco Ambrosetti, Raffaele Griffo, Roberto F.E. Pedretti, Antonia Pierobon, Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- Ugo Corrà , Massimo F. Piepoli, Summary Statement on Cardiopulmonary Exercise Testing in Chronic Heart Failure due to Left Ventricular Dysfunction Recommendations for Performance and Interpretation , Monaldi Archives for Chest Disease: Vol. 68 No. 1 (2007): Cardiac series
- Paolo Biagi, Luigi Abate, Heart failure, oxidative stress and allopurinol , Monaldi Archives for Chest Disease: Vol. 64 No. 1 (2005): Cardiac series
- M. Lusuardi, C. Lucioni, F. De Benedetto, S. Mazzi, C.M. Sanguinetti, C.F. Donner, GOLD severity stratification and risk of hospitalisation for COPD exacerbations , Monaldi Archives for Chest Disease: Vol. 69 No. 4 (2008): Pulmonary series
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
