Identification and management of cardiopulmonary risk in patients with chronic obstructive pulmonary disease: a multidisciplinary consensus and modified Delphi study
Chris P Gale, John R. Hurst, Nathaniel M. Hawkins, Jean Bourbeau, MeiLan K. Han, Carolyn Lam, Darcy D. Marciniuk, David A. Price, Daiana Stolz, Ty J. Gluckman, Shelley Zieroth, Ramesh Nadarajah, Robert P. Young, Dave Singh, Fernando J. Martínez, David D. Berg, Mohit Bhutani, the Global Working Group on Cardiopulmonary Risk, Amr Abdin, Dzifa Ahadzi, Albert B. Albay, Bernardino Alcázar Navarrete, Luís Alves, Sameera Ansari, Antonio Anzueto, Felix Barasa, David D. Berg, Andy Bevan, Mohit Bhutani, Giuseppe Biondi‐Zoccai, Jean Bourbeau, Raffaele Bugiardini, Daniela Calderaro, Arturo Cortés-Telles, Michael G. Crooks, Diego Echazarreta, Nabil Farag, Fredrico L A Fernandes, Frits M.E. Franssen, Suzanne Fredericks, C P Gale, Olga Milena García Morales, Melissa Gaviria, Bariş Gencer, Gonzalo Gianella, Kari Hanne Gjeilo, Ty J. Gluckman, Martha Gulati, MeiLan K Han, Nathaniel M Hawkins, Jeroen Hendriks, John R. Hurst, Anh-Thu Huynh Dang, Majdy Idrees, Tobin Joseph, Nadim Kanj, Ee Ming Khoo, Bruce Kirenga, Leonie Klompstra, Martha Kyriakou, Carolyn S P Lam, Bouchra Lamia, Le Thi Tuyet Lan, Dominik Linz, Angela H.E.M. Maas, Darcy D. Marciniuk, Fernando J. Martínez, Angela Massouh, Walter Mattarucco, Renata Gonçalves Mendes, Anant Mohan, Trine Moholdt, Majid Mokhtari, Felicia Montero-Arias, C Münks-Lederer, Shigeo Muro, Ramesh Nadarajah, Kazuhiro Nakao, Yoko M. Nakao, Thu Nguyen Ngoc Phuong, Johanna O’Callaghan, Demosthenes B. Panagiotakos, Alberto Papi, Gerardo Payró, Massimo Piepoli, Marija Polovina, Bogdan A Popescu, David Price, Hany Ragy, Keerthenan Raveendra, Christopher M. Reid, Catherine Reynolds, Antônio Luiz Pinho Ribeiro, Richard Russell, Lavanya Saiva, Juliana Salas Segura, Julie Sanders, R.J. Scott, Terence Seemungal, Dinesh Shrikrishna
Abstract
AIMS: Cardiovascular disease is a common comorbidity in chronic obstructive pulmonary disease. Yet, cardiovascular disease and risk are underdiagnosed in chronic obstructive pulmonary disease and are often undertreated, increasing the risk of cardiopulmonary events. METHODS AND RESULTS: We formed a Global Working Group of experts in chronic obstructive pulmonary disease and cardiovascular disease to produce a consensus statement detailing the identification and management of cardiopulmonary risk in patients with chronic obstructive pulmonary disease. We conducted virtual meetings supplemented by remote working and communication. The Chairs (C.P.G., M.B.) proposed a draft consensus statement, which was further developed by the Global Working Group. The selection of the final consensus statement and key points were obtained using the modified Delphi method. The consensus statement is, 'Given the high burden of fatal and non-fatal major cardiovascular and respiratory events in patients with COPD it is important that cardiopulmonary risk is assessed and managed'. Patients with cardiovascular risk factors or disease who have regular cough or expectoration, recurrent 'chest infections', a significant smoking history, or dyspnoea should complete spirometry to confirm the presence of chronic obstructive pulmonary disease. Prevalent and incident cardiovascular disease and risk in patients with chronic obstructive pulmonary disease, including heart failure, dyslipidaemia, hypertension, ischaemic heart disease, and atrial fibrillation, should be managed according to clinical guidelines. In addition, chronic obstructive pulmonary disease exacerbation risk in patients with chronic obstructive pulmonary disease should be addressed to reduce cardiopulmonary risk. Enhanced integration with specialists in cardiology, pulmonology, and primary care is recommended. CONCLUSION: The identification and management of cardiopulmonary risk in patients with chronic obstructive pulmonary disease are an unmet public health need that can be addressed through shared understanding and multidisciplinary working to improve cardiopulmonary outcomes.