Why?  Cardiovascular should now be part of our COPD reviews in Primary Care
When I first started my training in Chronic Obstructive Pulmonary Disease (COPD) management it was all about the lungs.  Now there has been a shift in the way we manage these patients, which includes cardiovascular system.   This comes following many studies indicating that even after early diagnosis of COPD the independent risk of a sudden cardiac event increases significantly.   Also finding that a cardiovascular event was more likely when a patient was hospitalised due to an exacerbation of COPD  and in most cases was the actual cause of death.

This starts to highlight the obvious links between the cardiovascular and respiratory system and how interconnected they really are. 
So? what does this mean for our future COPD management in primary care?
The need to focus on reducing hospitalisation for our COPD patients with more in-depth COPD reviews which also keep the heart healthy. 
• Early intervention with our ICS therapy 
• Check Eosinophils – Is there a trend of high levels 
• Leg swelling when asking about their level of shortness of breath (SOB) 
• Blood pressure 
• ECG 
• Bloods – Full Blood Count, Iron, B12, Thyroid, HbA1C, Lipids 
• Chest Xray – (If appropriate, needs to be based on individual cases) 

The above are some suggestions on what you can add into your COPD review to ensure the heart is equally protected. Symptoms of COPD and cardiovascular disease can often overlap but are treated very differently. If we can start screening these patients at their reviews then we think differently about what treatment that patient might actually need. This is about prevention as well as improving the patient’s life expectancy by minimising symptoms and worsening outcomes due to their inevitable exacerbations. 

Anna Hargreaves
Nurse practitioner,  with a special interest in respiratory 
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