Heart failure and chronic obstructive pulmonary disease: the challenges facing physicians and health services

Eur Heart J. 2013 Sep;34(36):2795-803. doi: 10.1093/eurheartj/eht192. Epub 2013 Jul 5.


Pulmonary disease is common in patients with heart failure, through shared risk factors and pathophysiological mechanisms. Adverse pulmonary vascular remodelling and chronic systemic inflammation characterize both diseases. Concurrent chronic obstructive pulmonary disease presents diagnostic and therapeutic challenges, and is associated with increased morbidity and mortality. The cornerstones of therapy are beta-blockers and beta-agonists, whose pharmacological properties are diametrically opposed. Each disease is implicated in exacerbations of the other condition, greatly increasing hospitalizations and associated health care costs. Such multimorbidity is a key challenge for health-care systems oriented towards the treatment of individual diseases. Early identification and treatment of cardiopulmonary disease may alleviate this burden. However, diagnostic and therapeutic strategies require further validation in patients with both conditions.

Keywords: Adrenergic beta-agonists; Adrenergic beta-antagonists; Chronic obstructive pulmonary disease; Heart failure.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Agonists / therapeutic use
  • Adrenergic beta-Antagonists / therapeutic use
  • Costs and Cost Analysis
  • Diagnosis, Differential
  • Drug Therapy, Combination
  • Early Diagnosis
  • Echocardiography
  • Genetic Predisposition to Disease / genetics
  • Heart Failure / complications
  • Heart Failure / diagnosis
  • Heart Failure / drug therapy*
  • Humans
  • Natriuretic Peptides / metabolism
  • Practice Guidelines as Topic
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Randomized Controlled Trials as Topic
  • Respiratory Function Tests
  • Risk Factors


  • Adrenergic beta-Agonists
  • Adrenergic beta-Antagonists
  • Natriuretic Peptides