Identification and management of cardiopulmonary risk in patients with COPD: a multidisciplinary consensus and modified Delphi study

Chris P Gale^{1

2

3}, John R Hurst⁴, Nathaniel M Hawkins⁵, Jean Bourbeau⁶, MeiLan K Han⁷, Carolyn S P Lam⁸, Darcy D Marciniuk⁹, David Price^{10

11}, Daiana Stolz^{12

13}, Ty Gluckman¹⁴, Shelley Zieroth¹⁵, Ramesh Nadarajah^{1

2

3}, Robert P Young¹⁶, Dave Singh¹⁷, Fernando J Martinez¹⁸, David D Berg¹⁹, Mohit Bhutani²⁰; Global Working Group on Cardiopulmonary Risk

Collaborators, Affiliations

Collaborators

Global Working Group on Cardiopulmonary Risk:
Amr Abdin, Dzifa Ahadzi, Albert B Albay, Bernardino Alcázar Navarrete, Luís Alves, Sameera Ansari, Antonio Anzueto, Felix Barasa, David D Berg, Andy Bevan, Mohit Bhutani, Giuseppe Biondi-Zoccai, Jean Bourbeau, Raffaele Bugiardini, Daniela Calderaro, Arturo Cortes-Telles, Michael G Crooks, Diego F Echazarreta, Nabil Farag, Fredrico L A Fernandes, Frits M E Franssen, Suzanne Fredericks, Chris P Gale, Olga M García Morales, Maria C Gaviria, Baris Gencer, Gonzalo Ernesto Gianella Malca, Kari Hanne Gjeilo, Ty Gluckman, Martha Gulati, MeiLan K Han, Nathaniel M Hawkins, Jeroen M Hendriks, John R Hurst, Anh-Thu Huynh Dang, Majdy M Idrees, Tobin Joseph, Nadim Kanj, Ee Ming Khoo, Bruce Kirenga, Leonie Klompstra, Martha Kyriakou, Carolyn S P Lam, Bouchra Lamia, Le Thi Tuyet Lan, Dominik Linz, Angela H E M Maas, Darcy D Marciniuk, Fernando J Martinez, Angela Massouh, Walter Mattarucco, Renata G Mendes, Anant Mohan, Trine Moholdt, Majid Mokhtari, Felicia Montero-Arias, Claudia Münks-Lederer, Shigeo Muro, Ramesh Nadarajah, Kazuhiro Nakao, Yoko M Nakao, Thu Nguyen Ngoc Phuong, Johanna O'Callaghan, Demosthenes Panagiotakos, Alberto Papi, Gerardo Payro, Massimo Piepoli, Marija Polovina, Bogdan A Popescu, David Price, Hany I Ragy, Keerthenan Raveendra, Christopher M Reid, Catherine Reynolds, Antonio Luiz P Ribeiro, Richard E K Russell, Lavanya Saiva, Juliana Salas Segura, Julie Sanders, Raewyn J Scott, Terence Seemungal, Dinesh Shrikrishna, Sami O Simons, Dave Singh, Yuanlin Song, Daiana Stolz, Abirami Subramaniam, Yongchang Sun, Raj Thakkar, Frederik Trinkmann, Izabella Uchmanowicz, Viola Vaccarino, Lowie E G W Vanfleteren, Rajesh Vedanthan, Tonya Winders, Jianhua Wu, Robert P Young, Jinping Zheng, Min Zhou, Shelley Zieroth

Affiliations

¹ Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
² Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
³ Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom.
⁴ UCL Respiratory, University College London, London, UK.
⁵ Division of Cardiology, University of British Columbia, Vancouver, Canada.
⁶ Department of Medicine, Respiratory Division McGill University Health Centre, Quebec, Canada.
⁷ Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan, USA.
⁸ National Heart Centre Singapore and Duke-National University of Singapore, Singapore.
⁹ Division of Respirology, Critical Care and Sleep Medicine; University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁰ Observational and Pragmatic Research Institute, Singapore, Singapore.
¹¹ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
¹² Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
¹³ Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg.
¹⁴ Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence Heart Institute, Portland, Oregon, USA.
¹⁵ Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁶ Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
¹⁷ Medicines Evaluation Unit, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK.
¹⁸ Division of Pulmonary, Critical Care and Allergy, University of Massachusetts, Worcester, MA, USA.
¹⁹ Cardiovascular Division, TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
²⁰ Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada.

PMID: 40037333
DOI: 10.1093/eurjpc/zwaf119

Identification and management of cardiopulmonary risk in patients with COPD: a multidisciplinary consensus and modified Delphi study

Chris P Gale et al. Eur J Prev Cardiol. 2025.

. 2025 Mar 3:zwaf119.

doi: 10.1093/eurjpc/zwaf119. Online ahead of print.

Authors

Collaborators

Global Working Group on Cardiopulmonary Risk:
Amr Abdin, Dzifa Ahadzi, Albert B Albay, Bernardino Alcázar Navarrete, Luís Alves, Sameera Ansari, Antonio Anzueto, Felix Barasa, David D Berg, Andy Bevan, Mohit Bhutani, Giuseppe Biondi-Zoccai, Jean Bourbeau, Raffaele Bugiardini, Daniela Calderaro, Arturo Cortes-Telles, Michael G Crooks, Diego F Echazarreta, Nabil Farag, Fredrico L A Fernandes, Frits M E Franssen, Suzanne Fredericks, Chris P Gale, Olga M García Morales, Maria C Gaviria, Baris Gencer, Gonzalo Ernesto Gianella Malca, Kari Hanne Gjeilo, Ty Gluckman, Martha Gulati, MeiLan K Han, Nathaniel M Hawkins, Jeroen M Hendriks, John R Hurst, Anh-Thu Huynh Dang, Majdy M Idrees, Tobin Joseph, Nadim Kanj, Ee Ming Khoo, Bruce Kirenga, Leonie Klompstra, Martha Kyriakou, Carolyn S P Lam, Bouchra Lamia, Le Thi Tuyet Lan, Dominik Linz, Angela H E M Maas, Darcy D Marciniuk, Fernando J Martinez, Angela Massouh, Walter Mattarucco, Renata G Mendes, Anant Mohan, Trine Moholdt, Majid Mokhtari, Felicia Montero-Arias, Claudia Münks-Lederer, Shigeo Muro, Ramesh Nadarajah, Kazuhiro Nakao, Yoko M Nakao, Thu Nguyen Ngoc Phuong, Johanna O'Callaghan, Demosthenes Panagiotakos, Alberto Papi, Gerardo Payro, Massimo Piepoli, Marija Polovina, Bogdan A Popescu, David Price, Hany I Ragy, Keerthenan Raveendra, Christopher M Reid, Catherine Reynolds, Antonio Luiz P Ribeiro, Richard E K Russell, Lavanya Saiva, Juliana Salas Segura, Julie Sanders, Raewyn J Scott, Terence Seemungal, Dinesh Shrikrishna, Sami O Simons, Dave Singh, Yuanlin Song, Daiana Stolz, Abirami Subramaniam, Yongchang Sun, Raj Thakkar, Frederik Trinkmann, Izabella Uchmanowicz, Viola Vaccarino, Lowie E G W Vanfleteren, Rajesh Vedanthan, Tonya Winders, Jianhua Wu, Robert P Young, Jinping Zheng, Min Zhou, Shelley Zieroth

Affiliations

¹ Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
² Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
³ Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom.
⁴ UCL Respiratory, University College London, London, UK.
⁵ Division of Cardiology, University of British Columbia, Vancouver, Canada.
⁶ Department of Medicine, Respiratory Division McGill University Health Centre, Quebec, Canada.
⁷ Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan, USA.
⁸ National Heart Centre Singapore and Duke-National University of Singapore, Singapore.
⁹ Division of Respirology, Critical Care and Sleep Medicine; University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁰ Observational and Pragmatic Research Institute, Singapore, Singapore.
¹¹ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
¹² Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
¹³ Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg.
¹⁴ Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence Heart Institute, Portland, Oregon, USA.
¹⁵ Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁶ Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
¹⁷ Medicines Evaluation Unit, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK.
¹⁸ Division of Pulmonary, Critical Care and Allergy, University of Massachusetts, Worcester, MA, USA.
¹⁹ Cardiovascular Division, TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
²⁰ Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada.

PMID: 40037333
DOI: 10.1093/eurjpc/zwaf119

Abstract

Background: Cardiovascular disease is a common comorbidity in chronic obstructive pulmonary disease (COPD). Yet cardiovascular disease and risk is under diagnosed in COPD and is often undertreated, increasing the risk of cardiopulmonary events.

Methods: We formed a Global Working Group of experts in COPD and cardiovascular disease to produce a consensus statement detailing the identification and management of cardiopulmonary risk in patients with COPD. We conducted virtual meetings supplemented by remote working and communication. The Chairs (CPG, MB) 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.

Results: 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 COPD. Prevalent and incident cardiovascular disease and risk in patients with COPD, including heart failure, dyslipidaemia, hypertension, ischaemic heart disease and atrial fibrillation, should be managed according to clinical guidelines. In addition, COPD exacerbation risk in patients with COPD should be addressed to reduce cardiopulmonary risk. Enhanced integration with specialists in cardiology, pulmonology and primary care is recommended.

Conclusions: The identification and management of cardiopulmonary risk in patients with COPD is an unmet public health need that can be addressed through shared understanding and multidisciplinary working to improve cardiopulmonary outcomes.

Keywords: cardiopulmonary risk; cardiovascular disease; chronic obstructive pulmonary disease.

Plain language summary

This paper, produced by the Global Working Group of experts in COPD and cardiovascular disease, is about the identification and management of cardiopulmonary risk in patients with COPD. Individuals with cardiovascular risk factors or disease who have a regular cough or expectoration, recurrent “chest infections”, a significant smoking history, or breathlessness should complete spirometry to confirm the presence of COPD.Cardiovascular disease and risk in individuals with COPD, including heart failure, dyslipidaemia, hypertension, ischaemic heart disease and atrial fibrillation, should be managed according to clinical guidelines.Identifying cardiopulmonary risk to prevent exacerbations of COPD, treat established cardiovascular disease, and reduce cardiovascular risk in patients with COPD offers the prospect to improve cardiopulmonary outcomes.

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Identification and management of cardiopulmonary risk in patients with COPD: a multidisciplinary consensus and modified Delphi study

Collaborators

Affiliations

Identification and management of cardiopulmonary risk in patients with COPD: a multidisciplinary consensus and modified Delphi study

Authors

Collaborators

Affiliations

Abstract

Plain language summary

LinkOut - more resources

Full Text Sources

Miscellaneous