Assessment of cardiopulmonary risk in COPD patients: Expert opinion formalized using the Delphi method

Background

Cardiovascular (CV) comorbidities are frequent in patients with chronic obstructive pulmonary disease (COPD), increasing individual morbidity and mortality. This observation has given rise to the concept of cardiopulmonary risk. However, assessment and management of CV risk in COPD patients is highly variable in practice. Cardiologists' and pulmonologists' knowledge and understanding of cardiopulmonary risk and its assessment in COPD patients, along with the management of special situations, were analyzed using the Delphi consensus methodology.

Study Design and Methods

A Steering Committee of ten experts (five cardiologists and five pulmonologists) developed a questionnaire covering 73 clinical situations grouped into 31 statements. This Steering Committee recommended a panel of expert respondents with clinical experience. The Delphi consensus methodology was applied in two rounds, with 74 respondents in the first round and 68 in the second. Consensus was defined as agreement or disagreement by >75 % of respondents.

Results

The panel agreed that COPD patients face elevated CV risk independently of other risk factors. Consensus was reached on systematically assessing CV risk factors in COPD patients and the necessity for cardiological consultation and arterial imaging (coronary, supra-aortic trunks) if CV risk scores are high. The panel opposed routine Holter EKG use, but recommended both cardiological and pneumological investigations in cases of disproportionate dyspnea. Minor disagreements emerged between pulmonologists and cardiologists about abdominal aortic aneurysm screening, glycated hemoglobin testing, and specific CV assessments post COPD exacerbation.

Interpretation

This Delphi report summarizes expert cardiologist and pulmonologist perspectives on CV risk assessment in COPD patients, emphasizing the need for integrated management of respiratory and CV conditions. These findings demonstrate the importance of a multidisciplinary approach and suggest that while some practical aspects of CV assessment in COPD patients are the subject of clear consensus, other areas require further research to develop precise protocols.