Undiagnosed and undertreated heart disease in hospitalised patients with exacerbations of chronic obstructive pulmonary disease (COPD)

Background: Heart disease is common in COPD and often underdiagnosed or undertreated. COPD exacerbation (ECOPD) is followed by high rates of adverse cardiac events. We aimed to report the diagnostic and therapeutic gap for heart disease in ECOPD. Methods: Consenting patients hospitalised with ECOPD were randomised (1:1) to structured cardiac assessment (SCA, including echocardiography, 24-hour ECG and CT coronary artery calcium score [CACS]) or usual care (UC). Diagnoses and treatment were based on current international guidance. Results: 94 patients were recruited: 38 (40%) male; mean (SD) age 71 (7) and FEV1% 49 (18); median (IQR) DECAF score 1 (0-2). Median length of stay (IQR) 6 days (3-8); 20% required acute NIV and 2 died in hospital. 32 (34%) patients had ≥1 known heart disease (Table 1). In known moderate to severe LVSD or previous MI, only 44% were being treated with beta blockers and 31% with ACEi or ARB. SCA found a new cardiac diagnosis in 35 (74%) patients, with LVSD in 26% and coronary artery disease (CAD) in 49%. SCA changed management (new or intensified drug therapy, or specialist follow-up) in 31 (66%) patients. Conclusion: In patients with ECOPD, known heart disease is common and often inadequately treated. A structured cardiac assessment found diagnoses leading to treatment change in 66%. Closing the diagnostic and treatment gap in COPD could yield major patient benefit.