Tuberc Respir Dis > Volume 84(2); 2021 > Article
Deshmukh and Khanna: The Burden of Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases: A Non-Western Perspective
Our previous article summarized the prevalence, complications, and implications of managing chronic obstructive pulmonary disease (COPD) in cardiovascular disorders (CVD) [1]. A critical limitation of the review was the predominance of cardiovascular disease and comorbid COPD data from the United States and Europe. This was mainly due to greater cardiovascular disease registries in the United States and Europe vs. the rest of the world. It becomes necessary to highlight a “non-Western” perspective for the prevalence of COPD in CVD at the regional level for guiding clinical decisions that will optimize resources and improve patients’ quality of life.
We reviewed the literature for the studies, which captured the status of comorbid COPD in cardiac patients, and were conducted in Asia, the Middle East, Africa, and South America conducted between 1981 to May 2020. The prevalence of COPD in heart failure (HF) and COPD in ischemic heart disease (IHD) and atrial fibrillation (AF) across different regions have been summarized in Tables 1 and 2, respectively.
One of the critical limitations of the evidence presented above has been the use of history/physical examination to diagnose COPD in cardiovascular disease patients. The prevalence varies from 3% to 30% in HF; the differences in prevalence can be accounted by reliance on clinical examination/history/medical records, instead of lung function tests, to make a diagnosis. We now know that use of history/physical examination/medication can lead to both over-diagnosis and under-diagnosis of COPD. However, in the regions under consideration, it is prudent to assume that under-diagnosis of COPD is much more common than over-diagnosis, leading to poor health outcomes and increased healthcare costs in the long run. Another factor to look at is the general prevalence of COPD in the country where studies were conducted. One would expect at-least equal or ideally higher prevalence of COPD in HF/AF/IHD versus general population (Table 1) because of the common risk factors involved in pathogenesis of both COPD and heart disease. In certain studies such as the one by Barretto et al. [2], the drastic difference in study reported COPD prevalence and general COPD prevalence might be due to recruiting bias and/or improper evaluation of airflow limitation leading to under-diagnosis of COPD.
Based on the evidence, we found that the burden of undiagnosed COPD in CVD remains high in the non-western regions of the world. Not surprisingly, 23% of patients with CVD have been shown to have spirometry-confirmed COPD in India [3]. In the middle east, 91.5% of patients with IHD with COPD were not previously diagnosed with COPD [4]. The results highlight the importance of active screening for COPD in CVD patients in these regions because of the potential to reduce long-term healthcare costs and morbidity amidst the resource constraints and predominance of risk factors for COPD and CVD progression.

Notes

Authors’ Contributions

Conceptualization: Deshmukh K, Khanna A. Methodology: Deshmukh K, Khanna A. Data curation: Deshmukh K, Khanna A. Investigation: Deshmukh K, Khanna A. Writing - original draft preparation: Deshmukh K, Khanna A. Writing - review and editing: Deshmukh K, Khanna A. Approval of final manuscript: all authors.

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Table 1.
Prevalence of COPD in HF registries outside of Europe and the United States
Study Prevalence of COPD in the study (%) Prevalence of COPD in general population by spirometry (%) Method of COPD diagnosis Country Region
CONAREC-1999 [5] 16.10 14.5 [6] History and/or clinical examination Argentina South America
IC-SAC-2002 [5] 19 Argentina
IC-SAC-2004 [5] 13.80 Argentina
CONAREC-2004 [5] 13.80 Argentina
Barretto et al. [2] 3.85 15.8 [7] Brazil
Niteroi Study [8] 23 Brazil
INTER-CHF - South America [9] 10 Argentina, Chile, Colombia, and Ecuador
Yoshihisa et al. [10] 28 8.6 [11] Spirometry Japan Asia
Onishi et al. [12] 27 Spirometry Japan
JASPER HHF [13] 7.70 Medical records Japan
KorAHF [14] 11 13.4 [15] Clinical and/or history Korea
China PEACE [16] 30.40 13.6 [17] China
INTER-CHF - China [9] 8 China
HERO HF [18] 9.50 China
Trivandrum Heart Failure registry [19] 15.40 4.2 [20] India
INTER_CHF India [9] 16 India
INTER_CHF_Malaysia and Philipines [9] 4 Malaysia and Philippines
INTER-CHF Middle east [9] 4 Egypt, Qatar, and Saudi Arabia Middle East
Alhabeeb et al. [21] 19.70 4.2 [22] Saudi Arabia
INTERCHF Africa [9] 2 Mozambique, Nigeria, South Africa, Sudan, and Uganda Africa

COPD: chronic obstructive pulmonary disease; HF: heart failure.

Table 2.
Prevalence of COPD in IHD/AF registries outside of Europe and the United States
Prevalence of COPD in the study (%) Method of COPD diagnosis Country Region
IHD
Gagliardi et al. [23] 3.9 Medical records/clinical examination/history Argentina South America
Garcia Aurelio et al. [24] 6 Argentina
Korea AMI Registry [25] 2.1 Korea Asia
National Health Insurance database [26] 28.3 Taiwan
Das et al. [27] 52 Spirometry India
Mahendra et al. [28] 11 India
Jayamani and Chopra [29] 11.5 India
Khassawneh et al. [4] 15.7 Jordan Middle East and Africa
GULF RACE [30] 5.3 Medical records Bahrain, Kuwait, Qatar, Oman, United Arab Emirates, and Yemen
Ibnian et al. [31] 12.4 Spirometry Jordan
Yangui et al. [32] 20.5 Tunisia
AF
Albina et al. [33] 7.7 Medical records/clinical examination/history Argentina South America
Yang et al. [34,35] 11.7 Spirometry China Asia
JCARE-CARD [36] 6.2 Medical records/clinical examination/history Japan
IHRS-AF [37] 7.8 India
GULF SAFE [38] 5.3 Bahrain, Kuwait, Qatar, Oman, United Arab Emirates, and Yemen Middle East

COPD: chronic obstructive pulmonary disease; IHD: ischemic heart disease; AF: atrial fibrillation.

REFERENCES

1. Deshmukh K, Khanna A. Implications of managing chronic obstructive pulmonary disease in cardiovascular diseases. Tuberc Respir Dis 2021;84:35-45.
crossref
2. Barretto AC, Nobre MR, Wajngarten M, Canesin MF, Ballas D, Serro-Azul JB. Heart failure at a large tertiary hospital of Sao Paulo. Arq Bras Cardiol 1998;71:15-20.
crossref
3. Muralimohan BV, Ekbote G, Tousheed SZ, Ramanjenaya R. Prevalence of COPD in vascular diseases. Eur Respir J 2015;46:PA1131.
crossref
4. Khassawneh BY, Samrah SM, Jarrah MI, Ibdah RK, Ibnian AM, Almistarehi AW, et al. Prevalence of undiagnosed COPD in male patients with coronary artery disease: a cross-sectional study in Jordan. Int J Chron Obstruct Pulmon Dis 2018;13:2759-66.
crossref pmid pmc
5. Perna ER, Barbagelata A, Grinfeld L, Garcia Ben M, Cimbaro Canella JP, Bayol PA, et al. Overview of acute decompensated heart failure in Argentina: lessons learned from 5 registries during the last decade. Am Heart J 2006;151:84-91.
crossref pmid
6. Echazarreta AL, Arias SJ, Del Olmo R, Giugno ER, Colodenco FD, Arce SC, et al. Prevalence of COPD in 6 urban clusters in Argentina: the EPOC.AR study. Arch Bronconeumol 2018;54:260-9.
crossref pmid
7. Menezes AM, Jardim JR, Perez-Padilla R, Camelier A, Rosa F, Nascimento O, et al. Prevalence of chronic obstructive pulmonary disease and associated factors: the PLATINO Study in Sao Paulo, Brazil. Cad Saude Publica 2005;21:1565-73.
pmid
8. Tavares LR, Victer H, Linhares JM, de Barros CM, Oliveira MV, Pacheco LC, et al. Epidemiology of decompensated heart failure in the city of Niteroi: EPICA - Niteroi Project. Arq Bras Cardiol 2004;82:125-8.
pmid
9. Dokainish H, Teo K, Zhu J, Roy A, AlHabib KF, ElSayed A, et al. Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. Lancet Glob Health 2017;5:e665-72.
pmid
10. Yoshihisa A, Takiguchi M, Shimizu T, Nakamura Y, Yamauchi H, Iwaya S, et al. Cardiovascular function and prognosis of patients with heart failure coexistent with chronic obstructive pulmonary disease. J Cardiol 2014;64:256-64.
crossref pmid
11. Minakata Y, Ichinose M. Epidemiology of COPD in Japan. Nihon Rinsho 2011;69:1721-6.
pmid
12. Onishi K, Yoshimoto D, Hagan GW, Jones PW. Prevalence of airflow limitation in outpatients with cardiovascular diseases in Japan. Int J Chron Obstruct Pulmon Dis 2014;9:563-8.
crossref pmid pmc
13. Sato Y, Yoshihisa A, Oikawa M, Nagai T, Yoshikawa T, Saito Y, et al. Prognostic impact of chronic obstructive pulmonary disease on adverse prognosis in hospitalized heart failure patients with preserved ejection fraction: a report from the JASPER registry. J Cardiol 2019;73:459-65.
crossref pmid
14. Lee SE, Cho HJ, Lee HY, Yang HM, Choi JO, Jeon ES, et al. A multicentre cohort study of acute heart failure syndromes in Korea: rationale, design, and interim observations of the Korean Acute Heart Failure (KorAHF) registry. Eur J Heart Fail 2014;16:700-8.
crossref pmid
15. Yoo KH, Kim YS, Sheen SS, Park JH, Hwang YI, Kim SH, et al. Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008. Respirology 2011;16:659-65.
crossref pmid
16. Yu Y, Gupta A, Wu C, Masoudi FA, Du X, Zhang J, et al. Characteristics, management, and outcomes of patients hospitalized for heart failure in China: the China PEACE Retrospective Heart Failure Study. J Am Heart Assoc 2019;8:e012884.
crossref pmid pmc
17. Fang L, Gao P, Bao H, Tang X, Wang B, Feng Y, et al. Chronic obstructive pulmonary disease in China: a nationwide prevalence study. Lancet Respir Med 2018;6:421-30.
crossref pmid pmc
18. Li L, Liu R, Jiang C, Du X, Huffman MD, Lam CSP, et al. Assessing the evidence-practice gap for heart failure in China: the Heart Failure Registry of Patient Outcomes (HERO) study design and baseline characteristics. Eur J Heart Fail 2020;22:646-60.
crossref pmid
19. Sanjay G, Jeemon P, Agarwal A, Viswanathan S, Sreedharan M, Vijayaraghavan G, et al. In-hospital and three-year outcomes of heart failure patients in South India: the Trivandrum Heart Failure Registry. J Card Fail 2018;24:842-8.
crossref pmid pmc
20. India State-Level Disease Burden Initiative CRD Collaborators. The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health 2018;6:e1363-74.
pmid pmc
21. Alhabeeb W, Elasfar A, AlBackr H, AlShaer F, Almasood A, Alfaleh H, et al. Clinical characteristics, management and outcomes of patients with chronic heart failure: results from the heart function assessment registry trial in Saudi Arabia (HEARTS-chronic). Int J Cardiol 2017;235:94-9.
crossref pmid
22. Al Ghobain M, Alhamad EH, Alorainy HS, Al Kassimi F, Lababidi H, Al-Hajjaj MS. The prevalence of chronic obstructive pulmonary disease in Riyadh, Saudi Arabia: a BOLD study. Int J Tuberc Lung Dis 2015;19:1252-7.
crossref pmid
23. Gagliardi JA, Charask A, Perna E, D’Imperio H, Bono J, Castillo Costa Y, et al. National survey of ST-segment elevation acute myocardial infarction in Argentina (ARGEN-IAM-ST). Rev Argent Cardiol 2016;84:524-33.

24. Garcia Aurelio M, Cohen Arazi H, Higa C, Gomez Santa Maria HR, Mauro VM, Fernandez H, et al. Acute myocardial infarction with persistent ST-segment elevation: SCAR (acute coronary syndromes in Argentina) multicenter registry from the Argentine Society of Cardiology. Rev Argent Cardiol 2014;82:275-84.

25. Lee JH, Park HS, Chae SC, Cho Y, Yang DH, Jeong MH, et al. Predictors of six-month major adverse cardiac events in 30-day survivors after acute myocardial infarction (from the Korea Acute Myocardial Infarction Registry). Am J Cardiol 2009;104:182-9.
crossref pmid
26. Su TH, Chang SH, Chen PC, Chan YL. Temporal trends in treatment and outcomes of acute myocardial infarction in patients with chronic obstructive pulmonary disease: a nationwide population-based observational study. J Am Heart Assoc 2017;6:e004525.
crossref pmid pmc
27. Das S, Mukherjee S, Kundu S, Mukherjee D, Ghoshal AG, Paul D. Presence and severity of COPD among patients attending cardiology OPD of a tertiary healthcare centre. J Indian Med Assoc 2010;108:406-9.
pmid
28. Mahendra M, S SK, Desai N, Bs J, Pa M. Evaluation for airway obstruction in adult patients with stable ischemic heart disease. Indian Heart J 2018;70:266-71.
crossref pmid
29. Jayamani M, Chopra RK. Prevalence of undiagnosed chronic obstructive pulmonary disease (COPD) in stable ischemic heart disease patients attending a cardiac clinic. Am J Respir Crit Care Med 2020;201:A5108.
crossref
30. Hadi HA, Zubaid M, Al Mahmeed W, El-Menyar AA, Ridha M, Alsheikh-Ali AA, et al. Prevalence and prognosis of chronic obstructive pulmonary disease among 8167 Middle Eastern patients with acute coronary syndrome. Clin Cardiol 2010;33:228-35.
crossref pmid pmc
31. Ibnian AM, Al-Mistarehi AH, Zghayer AA, Abuqudairi SI, Samrah SM, Jarrah MI, et al. Undiagnosed chronic obstructive pulmonary disease in patients undergoing cardiac catheterization. Am J Respir Crit Care Med 2018;197:A5061.

32. Yangui F, Touil A, Antit S, Zakhama L, Youssef SB, Charfi MR. Prevalence of lung function abnormalities in smokers with ischemic heart disease. Eur Respir J 2019;54:PA2667.
crossref
33. Albina G, De Luca J, Conde D, Giniger A. Atrial fibrillation: an observational study with outpatients. Pacing Clin Electrophysiol 2014;37:1485-91.
crossref pmid
34. Yang YM, Shao XH, Zhu J, Zhang H, Liu Y, Gao X, et al. Risk factors and incidence of stroke and MACE in Chinese atrial fibrillation patients presenting to emergency departments: a national wide database analysis. Int J Cardiol 2014;173:242-7.
crossref pmid
35. Huang B, Yang Y, Zhu J, Liang Y, Zhang H, Tian L, et al. Clinical characteristics and prognostic significance of chronic obstructive pulmonary disease in patients with atrial fibrillation: results from a multicenter atrial fibrillation registry study. J Am Med Dir Assoc 2014;15:576-81.
crossref pmid
36. Hamaguchi S, Yokoshiki H, Kinugawa S, Tsuchihashi-Makaya M, Yokota T, Takeshita A, et al. Effects of atrial fibrillation on long-term outcomes in patients hospitalized for heart failure in Japan: a report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 2009;73:2084-90.
crossref pmid
37. Vora A, Kapoor A, Nair M, Lokhandwala Y, Narsimhan C, Ravikishore AG, et al. Clinical presentation, management, and outcomes in the Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF) registry. Indian Heart J 2017;69:43-7.
crossref pmid
38. Domek M, Li YG, Gumprecht J, Asaad N, Rashed W, Alsheikh-Ali A, et al. One-year all-cause mortality risk among atrial fibrillation patients in Middle East with and without diabetes: the Gulf SAFE registry. Int J Cardiol 2020;302:47-52.
crossref pmid


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