Implications of Managing Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Globally, cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are the leading causes of the noncommunicable disease burden. Overlapping symptoms such as breathing difficulty and fatigue, with a lack of awareness about COPD among physicians, are key reasons for under-diagnosis and resulting sub-optimal care relative to COPD. Much has been published in the past on the pathogenesis and implications of cardiovascular comorbidities in COPD. However, a comprehensive review of the prevalence and impact of COPD management in commonly encountered cardiac diseases is lacking. The purpose of this study was to summarize the current knowledge regarding the prevalence of COPD in heart failure, ischemic heart disease, and atrial fibrillation. We also discuss the real-life clinical presentation and practical implications of managing COPD in cardiac diseases. We searched PubMed, Scopus, EMBASE, and Google Scholar for studies published 1981–May 2020 reporting the prevalence of COPD in the three specified cardiac diseases. COPD has high prevalence in heart failure, atrial fibrillation, and ischemic heart disease. Despite this, COPD remains under-diagnosed and under-managed in the majority of patients with cardiac diseases. The clinical implications of the diagnosis of COPD in cardiac disease includes the recognition of hyperinflation (a treatable trait), implementation of acute exacerbations of COPD (AECOPD) prevention strategies, and reducing the risk of overuse of diuretics. The pharmacological agents for the management of COPD have shown a beneficial effect on cardiac functions and mortality. The appropriate management of COPD improves the cardiovascular outcomes by reducing hyperinflation and preventing AECOPD, thus reducing the risk of mortality, improving exercise tolerance, and quality of life.

Related collections

Most cited references 88

Record: found
Abstract: found
Article: found

Is Open Access

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Yuan-Pang Wang, Maheswar Satpathy, Mathilde Touvier … (2018)

Summary Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer’s disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228). Interpretation The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.

0 comments Cited 1840 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes.

Benjamin Steinberg, Xin Zhao, Paul A Heidenreich … (2012)

Heart failure with preserved ejection fraction (EF) is a common syndrome, but trends in treatments and outcomes are lacking. We analyzed data from 275 hospitals in Get With the Guidelines-Heart Failure from January 2005 to October 2010. Patients were stratified by EF as reduced EF (EF <40% [HF-reduced EF]), borderline EF (40%≤EF<50% [HF-borderline EF]), or preserved (EF ≥50% [HF-preserved EF]). Using multivariable models, we examined trends in therapies and outcomes. Among 110 621 patients, 50% (55 083) had HF-reduced EF, 14% (15 184) had HF-borderline EF, and 36% (40 354) had HF-preserved EF. From 2005 to 2010, the proportion of hospitalizations for HF-preserved EF increased from 33% to 39% (P<0.0001). In multivariable analyses, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge decreased in all EF groups, and β-blocker use increased. Patients with HF-preserved EF less frequently achieved blood pressure control (adjusted odds ratio, 0.44 versus HF-reduced EF; P<0.001) and were more likely discharged to skilled nursing (adjusted odds ratio, 1.16 versus HF-reduced EF; P<0.001). In-hospital mortality for HF-preserved EF decreased from 3.32% in 2005 to 2.35% in 2010 (adjusted odds ratio, 0.89 per year; P=0.01) but was stable for patients with HF-reduced EF (3.03%-2.83%; adjusted odds ratio, 0.93 per year; P=0.10). Hospitalization for HF-preserved EF is increasing relative to HF-reduced EF. Although in-hospital mortality for patients with HF-preserved EF declined over the study period, an important opportunity remains for identifying evidence-based therapies in patients with HF-preserved EF.

0 comments Cited 238 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Exercise-based cardiac rehabilitation for adults with heart failure

Linda Long, Ify Mordi, Charlene Bridges … (2019)

Chronic heart failure (HF) is a growing global health challenge. People with HF experience substantial burden that includes low exercise tolerance, poor health‐related quality of life (HRQoL), increased risk of mortality and hospital admission, and high healthcare costs. The previous (2014) Cochrane systematic review reported that exercise‐based cardiac rehabilitation (CR) compared to no exercise control shows improvement in HRQoL and hospital admission among people with HF, as well as possible reduction in mortality over the longer term, and that these reductions appear to be consistent across patient and programme characteristics. Limitations noted by the authors of this previous Cochrane Review include the following: (1) most trials were undertaken in patients with HF with reduced ( 18 years) with evidence of HF ‐ either HFrEF or HFpEF. Two review authors independently screened all identified references and rejected those that were clearly ineligible for inclusion in the review. We obtained full papers of potentially relevant trials. Two review authors independently extracted data from the included trials, assessed their risk of bias, and performed GRADE analyses. We included 44 trials (5783 participants with HF) with a median of six months' follow‐up. For this latest update, we identified 11 new trials (N = 1040), in addition to the previously identified 33 trials. Although the evidence base includes predominantly patients with HFrEF with New York Heart Association classes II and III receiving centre‐based exercise‐based CR programmes, a growing body of studies include patients with HFpEF and are undertaken in a home‐based setting. All included studies included a no formal exercise training intervention comparator. However, a wide range of comparators were seen across studies that included active intervention (i.e. education, psychological intervention) or usual medical care alone. The overall risk of bias of included trials was low or unclear, and we downgraded results using the GRADE tool for all but one outcome. Cardiac rehabilitation may make little or no difference in all‐cause mortality over the short term (≤ one year of follow‐up) (27 trials, 28 comparisons (2596 participants): intervention 67/1302 (5.1%) vs control 75/1294 (5.8%); risk ratio (RR) 0.89, 95% confidence interval (CI) 0.66 to 1.21; low‐quality GRADE evidence) but may improve all‐cause mortality in the long term (> 12 months follow up) (6 trials/comparisons (2845 participants): intervention 244/1418 (17.2%) vs control 280/1427 (19.6%) events): RR 0.88, 95% CI 0.75 to 1.02; high‐quality evidence). Researchers provided no data on deaths due to HF. CR probably reduces overall hospital admissions in the short term (up to one year of follow‐up) (21 trials, 21 comparisons (2182 participants): (intervention 180/1093 (16.5%) vs control 258/1089 (23.7%); RR 0.70, 95% CI 0.60 to 0.83; moderate‐quality evidence, number needed to treat: 14) and may reduce HF‐specific hospitalisation (14 trials, 15 comparisons (1114 participants): (intervention 40/562 (7.1%) vs control 61/552 (11.1%) RR 0.59, 95% CI 0.42 to 0.84; low‐quality evidence, number needed to treat: 25). After CR, a clinically important improvement in short‐term disease‐specific health‐related quality of life may be evident (Minnesota Living With Heart Failure questionnaire ‐ 17 trials, 18 comparisons (1995 participants): mean difference (MD) ‐7.11 points, 95% CI ‐10.49 to ‐3.73; low‐quality evidence). Pooling across all studies, regardless of the HRQoL measure used, shows there may be clinically important improvement with exercise (26 trials, 29 comparisons (3833 participants); standardised mean difference (SMD) ‐0.60, 95% CI ‐0.82 to ‐0.39; I² = 87%; Chi² = 215.03; low‐quality evidence). ExCR effects appeared to be consistent different models of ExCR delivery: centre vs. home‐based, exercise dose, exercise only vs. comprehensive programmes, and aerobic training alone vs aerobic plus resistance programmes. This updated Cochrane Review provides additional randomised evidence (11 trials) to support the conclusions of the previous version (2014) of this Cochane Review. Compared to no exercise control, CR appears to have no impact on mortality in the short term (< 12 months' follow‐up). Low‐ to moderate‐quality evidence shows that CR probably reduces the risk of all‐cause hospital admissions and may reduce HF‐specific hospital admissions in the short term (up to 12 months). CR may confer a clinically important improvement in health‐related quality of life, although we remain uncertain about this because the evidence is of low quality. Future ExCR trials need to continue to consider the recruitment of traditionally less represented HF patient groups including older, female, and HFpEF patients, and alternative CR delivery settings including home‐ and using technology‐based programmes. Exercise‐based cardiac rehabilitation for heart failure Background People with heart failure (HF) experience fatigue and shortness of breath. This negatively affects their activities of daily living and health‐related quality of life. They are at increased risk of hospital admission and death. Study characteristics We searched the scientific literature for randomised controlled trials (experiments in which two or more interventions, possibly including a control intervention or no intervention, are compared by randomly allocating participants to study groups). We looked at the effectiveness of exercise‐based rehabilitation compared with no exercise in adults (over 18 years of age) with heart failure. We considered HF due to reduced ejection fraction (HFrEF) (i.e. the chambers of the heart contract poorly, and, as a result, a smaller volume of blood is pumped around the body). We also considered HF due to preserved ejection fraction (HFpEF) (i.e. the chambers of the heart contract normally but do not relax efficiently, resulting in a smaller volume of blood pumped around the body). Our search is current to January 2018. Key results We found 44 studies that included 5783 people with HF, mainly HFrEF. The findings of this update are broadly consistent with those of the previous (2014) version of this Cochrane Review. They show important benefits of exercise‐based rehabilitation that include a probable reduction in the risk of overall hospital admissions in the short term, as well as the potential for reduction in heart failure admissions. The effect of exercise‐based rehabilitation on health‐related quality of life is uncertain due to very low‐quality evidence. Exercise‐based rehabilitation may make little or no difference in all‐cause mortality in trials with follow‐up less than 12 months. Further evidence is needed to better show the effects of exercise rehabilitation among people with HFpEF and the impact of alternative models of delivery, such as home‐based programmes. Quality of evidence Generally, recent trials have been better reported and are at low to moderate risk of bias. Using the GRADE method, we assessed the quality of evidence to range from high to very low across measured outcomes. Common reasons for downgrading outcomes include that results were inconsistent and/or imprecise.

0 comments Cited 179 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Tuberc Respir Dis (Seoul)

Journal ID (iso-abbrev): Tuberc Respir Dis (Seoul)

Journal ID (publisher-id): TRD

Title: Tuberculosis and Respiratory Diseases

Publisher: The Korean Academy of Tuberculosis and Respiratory Diseases

ISSN (Print): 1738-3536

ISSN (Electronic): 2005-6184

Publication date (Print): January 2021

Publication date (Electronic): 13 October 2020

Volume: 84

Issue: 1

Pages: 35-45

Affiliations

[1 ]Fuqua School of Business, Duke University, Durham, NC, USA

[2 ]Department of Pulmonary Medicine, Yashoda Hospital, Delhi, India

Author notes

Address for correspondence: Kartik Deshmukh, M.B.B.S. Fuqua School of Business, Duke University, Fuqua Drive, Durham, NC 27708, USA Phone: 1-919-3089590, Fax: 1-919-3089590 E-mail: Kartik.deshmukh@ 123456duke.edu , Deshmukh.kartik333@ 123456gmail.com

Author information

Kartik Deshmukh http://orcid.org/0000-0002-4781-017X

Article

Publisher ID: trd-2020-0088

DOI: 10.4046/trd.2020.0088

PMC ID: 7801809

PubMed ID: 33045814

SO-VID: 4b5f23af-db53-46a7-929d-e2e480c12335

License:

It is identical to the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/).

History

Date received : 29 July 2020

Date revision received : 31 August 2020

Date accepted : 13 October 2020

Comments

Comment on this article

scite_

Cited by 2

See all cited by

Most referenced authors 4,544

See all reference authors

Implications of Managing Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases

Read this article at

Abstract

Related collections

Biomarkers for Inflammatory Lung Disease

Most cited references 88

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes.

Exercise-based cardiac rehabilitation for adults with heart failure

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Categories

Comments

Comment on this article

Similar content 318

Cited by 2

Most referenced authors 4,544