Cardiovascular Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
JACC Heart Fail. 2019 Oct;7(10):823-833. doi: 10.1016/j.jchf.2019.05.009. Epub 2019 Sep 11.
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) coincide in a significant number of patients. Recent population-based registries suggest that spirometry is largely underused in patients with HF to diagnose comorbid COPD and that patients with COPD frequently do not receive the recommended beta-blocker (BB) treatment. This state-of-the-art review summarizes: 1) current challenges in the implementation of recommended spirometry for COPD diagnosis in patients with HF; and 2) current underuse and underdosing of BBs in patients with HF and COPD despite guideline recommendations. Open issues in the therapeutic management of patients with HF and COPD are discussed in the third section, including the use of the nonselective BB carvedilol, target BB doses in patients with HF and COPD, BB and bronchodilator management during HF hospitalization with and without COPD exacerbation, and the use of BBs in patients with COPD with right HF or free from cardiovascular disease. The whole scenario described herein advocates for a bipartisan initiative to drive immediate attention to the translation of guideline recommendations into clinical practice for patients with HF with co-occurring COPD.
心力衰竭（HF）和慢性阻塞性肺疾病（COPD）在大量患者中同时存在。最近的基于人群的登记研究表明，在 HF 患者中，肺量测定法在很大程度上未被用于诊断合并的 COPD，并且 COPD 患者经常未接受推荐的β受体阻滞剂（BB）治疗。这篇最新综述总结了：1）目前在 HF 患者中实施 COPD 诊断推荐肺量测定法所面临的挑战；2）尽管有指南建议，但 HF 和 COPD 患者中 BB 的使用不足和剂量不足。在第三部分中讨论了 HF 和 COPD 患者治疗管理中的未决问题，包括非选择性 BB 卡维地洛的使用、HF 和 COPD 患者的 BB 目标剂量、HF 住院期间伴或不伴 COPD 加重时 BB 和支气管扩张剂的管理，以及在合并右心 HF 或无心血管疾病的 COPD 患者中使用 BB。本文所述的整个情况提倡采取两党联合行动，立即关注将指南建议转化为同时患有 COPD 的 HF 患者的临床实践。
