Identification and management of cardiopulmonary risk in patients with chronic obstructive pulmonary disease: a multidisciplinary consensus and modified Delphi study

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.