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

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.