COPD prevalence in chronic heart failure

Introduction: COPD frequently coexists with chronic heart failure (CHF) leading to impaired prognosis as well as diagnostic and therapeutic challenges. However, lungfunctional data on COPD prevalence in CHF are scarce and COPD remains to be widely undiagnosed or misdiagnosed. The aim of this study was to determine COPD prevalence in CHF. Methods: In this cross-sectional study spirometry was performed in 220 CHF patients (78.2% male, median age 71 years [IQR 63-77] with left ventricular ejection fraction < 40% recruited from the outpatient cardiology department in two hospitals in The Netherlands. COPD was determined according to GOLD criteria (post-bronchodilator FEV1/FVC < 70%). Results: COPD was found by spirometry in 81 patients (36.8%). The majority had mild to moderate COPD (GOLD I/II 88.9%). Of these patients only 42 (51.9%) were known with a history of obstructive lung disease, whereas 39 (48.1%) had newly diagnosed COPD. By dividing the whole study population into groups of patients with and without a history of obstructive lung disease (n = 58 and n = 162 respectively), we found overdiagnosis of COPD in the first group (n = 16, 27.6%) and underdiagnosis of COPD in the latter group (n = 39, 24.1%) based on spirometry. Conclusion: COPD is a frequent co-morbidity in CHF with left ventricular systolic dysfunction, but is often unrecognized or even overdiagnosed. To avoid this and thus ensure adequate treatment of COPD in CHF, pulmonary function tests should be routinely obtained, preferably in a stable state of heart failure.