Abstract and Introduction
Abstract
Pulmonary disease is common in patients with heart failure, through shared risk factors and pathophysiological mechanisms. Adverse pulmonary vascular remodelling and chronic systemic inflammation characterize both diseases. Concurrent chronic obstructive pulmonary disease presents diagnostic and therapeutic challenges, and is associated with increased morbidity and mortality. The cornerstones of therapy are beta-blockers and beta-agonists, whose pharmacological properties are diametrically opposed. Each disease is implicated in exacerbations of the other condition, greatly increasing hospitalizations and associated health care costs. Such multimorbidity is a key challenge for health-care systems oriented towards the treatment of individual diseases. Early identification and treatment of cardiopulmonary disease may alleviate this burden. However, diagnostic and therapeutic strategies require further validation in patients with both conditions.
Introduction
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are leading causes of death worldwide. Through shared risk factors and pathogenic mechanisms the conditions frequently coexist, presenting diagnostic and therapeutic challenges for physicians. Each is an independent predictor of morbidity, mortality, impaired functional status, and health service use. Each is also powerfully associated with socioeconomic deprivation. The conditions therefore undermine the two fundamental goals of healthcare: to improve both the overall level and distribution of health. Healthcare internationally is dominated by individual disease approaches, lacking coordination and integration. Multimorbidity is a key challenge for these health systems. We review these challenges and provide direction for future research.