Challenges in the Early Diagnosis, Screening and Management of Heart Failure in Patients with Chronic Obstructive Pulmonary Disease

In patients with co-morbid CHF and COPD, the diagnosis of CHF can be delayed. It is also well known that left ventricular dysfunction can arise from progressive disease-related hyperinflation. Apart from the longitudinal risk of developing CHF in some patients, a short-term or subclinical risk of cardiac events has been reported after hospitalization for COPD exacerbation. Currently there are no data or strategies to support screening for the early diagnosis of CHF in patients with COPD. Similarly, pulmonary function testing results can also be confounding and inaccurate in establishing the severity of COPD during an active exacerbation of CHF. The hyperinflation of the lungs, which can alter LV geometry and mechanics, is at the root of many of the causes of LV underfilling, which eventually contributes to CHF. Conventional echocardiography can often miss subclinical myocardial dysfunction and hence make early diagnosis even more challenging. Advanced cardiac imaging modalities and revised echocardiographic parameters can help detect subclinical LV dysfunction and PH earlier, but there are no clinical outcome data to validate their routine use in day-to-day clinical practice. Beta-blockers are generally regarded as safe to be used for appropriate cardiovascular indications in patients with COPD, and recent trials have also established the safety of long-acting beta agonists for treating COPD in patients with elevated cardiac risk.