**Systemic inflammation and endothelial dysfunction serve as key mechanisms linking COPD to heart failure with preserved ejection fraction (HFpEF).** Despite this connection, COPD is not currently included as a variable in HFpEF risk scoring systems, according to a presentation at the 2024 GOLD COPD International Conference.
Jennifer Quint, MSc, PhD, FHEA, FRCP, a professor of respiratory epidemiology at Imperial College London, highlighted the diagnostic challenges posed by the overlap of COPD and HFpEF. She noted that HFpEF is often misdiagnosed in patients with COPD due to overlapping symptoms, leading to misinterpretation of signs.
**HFpEF and COPD: Shared Characteristics and Challenges**
HFpEF is characterized by a left ventricular ejection fraction over 50%, diastolic dysfunction, elevated left ventricular filling pressures, and increased natriuretic peptide levels. It is associated with conditions like obesity, hypertension, and kidney impairment, which complicates treatment strategies. Quint emphasized the need for personalized treatment approaches given the variability in patient profiles.
Systemic inflammation, endothelial dysfunction, and lung hyperinflation are the main mechanisms linking COPD to HFpEF. Quint stressed the importance of recognizing the symptom overlap between these conditions to reduce misdiagnoses.
**Demographics and Outcomes in COPD and HFpEF**
Patients with both COPD and HF are often older, male, and have advanced COPD (GOLD stage 3 or 4). Data show that HF outcomes vary based on HF subtype. For example:
– Acute COPD exacerbations occurred more frequently in HFpEF patients (38%) compared to HFmEF (29.9%) and HFrEF (29.4%).
– HF-specific hospital admissions were most common in HFrEF patients (20%) compared to HFpEF (15.5%) and HFmEF (15.8%).
Quint highlighted the critical role of COPD exacerbations, which increase the risk of acute cardiovascular events, including acute heart failure.
**Treatment Considerations for COPD and HFpEF**
Quint underscored that HF treatment is well tolerated in COPD patients and beta-blockers are not contraindicated for this population. She cited research showing that diagnosing and managing HF effectively in COPD patients can reduce the risk of exacerbations.
However, the impact of inhaled corticosteroids on cardiovascular disease remains unclear, and more research is needed. Quint also pointed out that the widely used H2FPEF scoring system for HFpEF does not include COPD as a variable, suggesting a need to revise risk assessment tools to account for COPD.
In conclusion, Quint emphasized the importance of recognizing COPD as an independent risk factor for poor outcomes in HF patients, advocating for more aggressive diagnosis and treatment strategies for HF in the COPD population.
