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International Journal of Chronic Obstructive Pulmonary Disease logoLink to International Journal of Chronic Obstructive Pulmonary Disease
. 2026 Aug 31;21:596426. doi: 10.2147/COPD.S596426

Addressing Cardiopulmonary Risk in COPD: A Multidisciplinary Expert Opinion Framework for the United States Healthcare System

Stephen Brunton 1,✉,*, Patrick A Cambier 2,*, Nathaniel Marchetti 3,*, Joel Solis 4,*
PMCID: PMC13545340  PMID: 42701440

Abstract

Chronic obstructive pulmonary disease (COPD) is a prevalent and devastating condition responsible for substantial morbidity and mortality in the United States (US). Although the burden of cardiopulmonary (CP) comorbidity in COPD is increasingly known, CP risk remains frequently under-recognized and suboptimally managed in routine clinical practice. Definitions of CP risk in COPD vary across the literature and clinical settings. CP risk may be broadly defined as the risk of serious respiratory and/or cardiovascular events in patients with COPD, including COPD exacerbations, myocardial infarction, stroke, heart failure decompensation, arrhythmia, and death. While current clinical guidelines recognize comorbidity, there remain no clear protocols for screening, risk assessment, or a coordinated multidisciplinary approach to address the CP risk in patients with COPD. To address these gaps, a multidisciplinary expert panel developed consensus-based guidance through an iterative process incorporating an expert-led narrative review supported by targeted desk searches alongside multiple rounds of expert input. This paper identifies critical gaps in the management of CP risk among patients with COPD in the US and outlines actionable steps towards improvement of care. Actionable recommendations include encouraging earlier screening and risk assessment to identify patients at risk of exacerbations and improving patient access to multidisciplinary teams, prompting earlier initiation or optimization of evidence-based treatment. Furthermore, implementation of fully coordinated treatment strategies through primary care settings and increasing the use of preventative strategies in the clinic such as spirometry, vaccination, and smoking cessation are recommended. By shifting to proactive, multidisciplinary care, healthcare practitioners can better address the complex needs of patients with COPD to reduce their CP risk and improve individual and population-level outcomes.

Keywords: cardiovascular diseases, pulmonary disease, comorbidity, exacerbations

Introduction

Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are common diseases in the United States (US) population that are responsible for substantial morbidity and mortality. In 2022, the estimated prevalence of COPD among adults in the US was 6.0%, and in 2021 there were an estimated 14.2 million affected individuals.1,2 Evidence further suggests that a substantial proportion of individuals with obstructive lung disease remain without a formal diagnosis.3 Chronic lower respiratory diseases (primarily consisting of COPD) were the fifth leading cause of death in 2023 in the US.4 CVD, a term that includes a range of disorders including coronary heart disease (CHD), heart failure (HF), arrhythmias, and stroke, remains a critical burden in the US, with the American Heart Disease and Stroke Statistical update (2017–2020) reporting that 127.9 million Americans (48.6%) over the age of 20 years have CVD.5 In 2023, the US Centers for Disease Control and Prevention (CDC) reported that 919,032 people died from CVD, equating to one in every three deaths.6 CVD is the most prevalent comorbidity among American patients with COPD, and is a major cause of mortality for these patients.7 Further, the prevalence of CVD in patients with COPD was found to be 59.6% in a cross-sectional study of data from the 2013–2018 National Health and Nutrition Examination Survey (NHANES).7 Beyond shared risk factors such as smoking, physical inactivity, and diabetes, the relationship between COPD and CVD is recognized as syndemic, driven by interacting socioeconomic determinants and both pathophysiological and pathobiological mechanisms that mutually exacerbate each other.8–12 The link with CVD is not exclusive to COPD, and other chronic inflammatory and pulmonary conditions, such as interstitial lung disease, pulmonary hypertension, and right-heart dysfunction have a similar bidirectional relationship with CVD.13,14 Observational evidence also suggests a causal relationship between COPD and CVD independent of concurrent traditional cardiovascular (CV) risk factors. This is evidenced by the association between reduced forced expiratory volume (FEV1) in the general population and incident CVD and CV mortality, as well as reduced vascular function and lung function following acute exacerbations.15–17 Abnormal lung function, including hyperinflation, may further compromise cardiac function, while hypoxemia may contribute to pulmonary vasoconstriction and vascular remodeling, resulting in right ventricular dysfunction.18,19 This evolving understanding of the underlying pathophysiology warrants improved risk stratification and ongoing monitoring to support earlier management of cardiopulmonary (CP) risk in patients with COPD. CP risk has been described as the risk of serious adverse CV events arising from the interaction of these conditions, including recurrent exacerbations, stroke, myocardial infarction, arrhythmia, heart failure decompensation, and death.11

COPD exacerbations are proposed by Singh et al (2024) as a core risk factor for CP events, because elevated CP risk stems from known multifactorial interactions between coexisting CP conditions.11 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines a COPD exacerbation as “an acute event with symptoms worsening over a few days (up to 14 days) and characterized by increased dyspnea and/or cough and sputum that may be accompanied by tachypnea and/or tachycardia….”.20 Exacerbations are grouped into categories according to severity (mild, moderate, severe) known as the Rome classification.21 This is based on six severity criteria, namely dyspnea, oxygen saturation, heart rate, respiratory rate, serum C-reactive protein, and in some cases, arterial blood gases.21

Exacerbations are frequent among patients with COPD, particularly those who have been recently diagnosed.22 A US database claims study of 239,158 newly diagnosed patients with COPD (2015–2021) found that 32.9% of patients experienced at least one moderate or severe exacerbation within 4 years of their diagnosis.22 COPD exacerbations are known to promote downstream pulmonary and cardiac events through three major identified mechanisms, among others: systemic inflammation, lung hyperinflation, and hypoxemia.10 Systemic inflammation, commonly observed in patients with COPD, is characterized by increased levels of inflammatory markers, such as chemokines, and can significantly contribute to the development of atherothrombosis while also increasing the risk of arrhythmia.11,23,24 Hyperinflation is defined as architectural damage and excess volume in the lungs, which can lead to reduced cardiac function and added right ventricular (RV) strain.11,25 Hypoxic vasoconstriction can cause pulmonary hypertension, and also leads to decreased cardiac function.11,26 Vascular function is impaired during and shortly after an acute exacerbation, reinforcing the notion that acute exacerbations of COPD (AECOPDs) are associated with both acute and long-term increased cardiac morbidity and mortality.16

Despite extensive literature describing the biological interactions between COPD and CVD, concrete action to reduce CP risk among patients with COPD in the US has not yet been adequately implemented.7–11 Unfortunately, care remains fragmented and reactive in nature. Healthcare delivery often remains specialty-focused, leading to treatment frameworks that target single diseases, without integrated CP care.9 These often specialty-focused approaches drive the need for change in COPD management, where more comprehensive and integrated care is required to increase proactivity and improve outcomes for patients. In response to this need, a taskforce of healthcare practitioners in the US, consisting of cardiologists, pulmonologists, primary care physicians, and advanced care practitioners, convened to discuss gaps and critical steps to achieve actionable change in CP management.

The objective of this paper is to identify and discuss current gaps in practice and proactive actions encouraged to be taken by key stakeholders, including clinicians and healthcare administrators to improve CP risk management among COPD patients with underestimated CP risk.

Methods

This is a narrative, expert-led review supported by targeted searches and consensus recommendations. Ten experts were invited to participate. Recommendations were solicited from an Expert Task Force, which comprised a multidisciplinary authoring panel of four clinician experts with direct expertise in COPD and CV comorbidity management, including two primary care physicians, one pulmonologist, and one interventional cardiologist (details of panel recruitment and experts are provided in the Supplementary Material).

Expert input was obtained through structured written feedback, annotated document review, and discussion during scheduled meetings. Expert contributions were synthesized by an independent facilitator into a set of draft recommendations that were distributed to all expert participants for review and comment. Draft recommendations underwent multiple iterative rounds of expert review, with revisions incorporated throughout to ensure alignment across the panel, until full consensus was reached.

Gaps in CP Risk Management in COPD in the US

While efforts are being made to improve awareness of the CP risk of COPD,27,28 lack of awareness continues to contribute to delayed diagnosis and therapeutic inertia.11 For instance, many patients with COPD are not evaluated by a cardiologist during an admission to the intensive care unit (ICU) in spite of these documented risks. GOLD guidance recognizes the CP risks associated with COPD and highlights the need for a more interdisciplinary approach to its management.20 GOLD guidance issued in 2023 encourages cardiologists to consider COPD in routine CV care, reflecting ongoing concerns about the low recognition of CP risk in this population.27

Current COPD management is guided by the annually updated GOLD Report,20 which acknowledges CVD as a frequent and clinically significant comorbidity, yet does not provide structured recommendations for screening, risk assessment, or integrated disease management.9 There are no widely-used guidelines in the US that address the CP risk in patients with COPD and current practice remains reactive. Proactive management involves the early identification and treatment of individuals with COPD at risk of exacerbations and major CP events, including optimization of the most current treatments.11,29 There is evidence on lung function decline prior to an exacerbation, and primary care clinicians can play a role in limiting disease progression via earlier “upstream” therapy and as a result, potential proactive management of CP risk.17 The lack of established algorithms or multidisciplinary care pathways detailing collaborative responsibilities, frequency of visits, and what pathways exist for cross specialty referral, limits the systematic identification and management of CP risk in this at-risk population.9

Siloed care in differing specialties fails to provide the integrated approach required to properly address COPD patients’ increased CP risk. There exists a gap in interdisciplinary collaborations between respiratory, cardiology, and primary care services, which could improve COPD disease risk management.29 To overcome current barriers of providing integrated care and achieve these enhanced outcomes, it will be beneficial to establish protocols by the respective discipline among healthcare practitioners and other stakeholders. Improving communication pathways between specialties will be key in implementing integrated and effective care solutions such as prompt initiation of care in at-risk individuals and integrated electronic healthcare records. Integrative care has already seen success at the cross-section of CV, metabolic, and renal diseases, and a similar framework can be applied to CP risk management in COPD.29 Fragmented care delivery is often a contributor to worse patient outcomes, and is usually caused by a breakdown of communications between hospital and outpatient services.30,31 It has been established that sub-optimal communication between primary care physicians at hospital discharge carries negative impacts for patients, and decreases the continuity of care.31 As such, there is a need for continuity of communication between specialist and primary care, independent of hospitalization. In cases of at-risk individuals, coordination between cardiology specialists, pulmonologists, and primary care is critical to ensure proper CP risk management and prevent exacerbation where possible.

Future Opportunities for Research and Advocacy

Serving as a possible example for COPD care, the multidisciplinary diabetes management framework effectively operates across three levels (Figure 1): at the clinical level, it integrates bidirectional screening between diabetes and CVD, intensive and targeted risk factor management (blood pressure, weight, diet, physical activity), systematic pharmacotherapy (disease-specific agents, ACEi/ARBs, statins), and optimization of glycemic control; at the care delivery level, expanded multidisciplinary teams encompassing nurse practitioners, pharmacists, dieticians, and diabetes educators deliver patient education, coaching, and peer support through integrated models anchored in primary care; and at the system level, registries, performance indicators, quality improvement initiatives, and aligned reimbursement structures sustain and reinforce the clinical and delivery components (Figure 1).9 Based on this precedent, multidisciplinary care, intensive risk factor management, and the systematic use of therapies that reduce CV risk offer a translatable framework for integrated CP care.9 Implementing these key elements into COPD care may drive actionable and meaningful improvements in patient outcomes.

Figure 1.

A diagram of a three-level healthcare framework: clinical, care delivery, and system levels. The figure shows a three-level framework, at clinical, care delivery, and system levels, illustrating a multidisciplinary approach to diabetes management. Under the clinical level, the framework includes bidirectional screening, risk factor management, and optimizing disease control. Under the care delivery level, it includes multidisciplinary teams, patient education, coaching, and peer support, and integrated delivery anchored in primary care. Under the system level, it includes registries, performance indicators, quality improvement initiatives, and aligned reimbursement structures.

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The three-level multidisciplinary diabetes management framework. Based on the framework described in Hawkins et al (2024).9

Raising awareness of CP risk among primary care physicians and specialists represents an important opportunity to support integrated care for at-risk patients. Developing effective educational tools for primary care physicians, cardiologists, pulmonologists, and patients with COPD is a priority for enhancing the awareness of CP risk. The current status of CP care and potential for improvements in clinical management have parallels with how cardiometabolic care has evolved. The links between diabetes and CVD were initially inadequately understood and addressed by the healthcare community.9 With a growing understanding of cardiometabolic risks, and integration of risk assessment and management of CV risk factors in patients with diabetes, patient outcomes have improved.9 Developing communication resources and public campaigns may be effective at raising a more comprehensive awareness of CP risks.18

Key elements for system-level improvements in care include establishing clear care pathways and developing protocols. In establishing clear pathways, efforts should be focused on closing gaps in existing care models and providing guidance on optimal strategies for managing CP risk.9 Developing structured recommendations or algorithms for screening, risk assessment, disease management, and coordinated multidisciplinary care has the potential to improve CP risk management in clinical practice.9 Reframing care around early CP risk detection and reduction through proactive approaches might improve outcomes and raise standards of care for patients.11 Proactive, integrated care combining routine spirometry with CV risk assessment and stratification may enable coordinated management between pulmonologists and cardiologists, timely referral for multidisciplinary interventions, and trend monitoring with the aim of preventing exacerbations through development of improved protocols.

Broader adoption of spirometry and the development of simpler, user-friendly devices to track FEV1 in everyday practice could enable earlier intervention and potentially help slow disease progression. Watz et al (2018) demonstrated that lung function, measured through FEV1, declined prior to the first reported symptoms of a moderate or severe exacerbation in patients with COPD, and did not improve to pre-exacerbation levels eight weeks after the event.17 Moderate exacerbation was defined by the study as an increase of at least two lower respiratory tract symptoms related to COPD (shortness of breath, sputum purulence, sputum production, wheezing, chest tightness, or cough), or the onset of two or more such symptoms, with at least one symptom lasting three or more days and for which antibiotics, systemic glucocorticoids or both were prescribed.17 A severe exacerbation was defined as an exacerbation event requiring hospitalization.17 Thus, even a single moderate exacerbation should be considered as a key opportunity to intervene, where accurate diagnosis, careful risk stratification, and team-based planning may assist a more effective and collaborative path forward.

Both pharmacological and non-pharmacological interventions have demonstrated potential in reducing CP risk, yet a clearly defined care pathway remains lacking, and undertreatment remains common.11 Preventive strategies such as ensuring timely vaccinations are equally important as part of a proactive approach to potentially reducing long-term risk. Improving vaccination registries and their maintenance would aim to address the current challenge of patients and clinicians being often unaware of vaccination status. In addition to early detection, the optimization of COPD disease management via smoking cessation, early initiation of pulmonary rehabilitation, and guideline directed medical therapy (such as earlier consideration of combination triple therapy) are associated with mortality reduction.11,32–35

Improving access to integrated care for patients with COPD could greatly improve health outcomes. For patients with frequent exacerbations, structured multidisciplinary meetings can enhance cross-discipline communication, engaging the full healthcare team including advanced practitioners, nurse practitioners, and physicians to support smoking cessation, vaccinations, and comprehensive COPD management. This would require the creation of and access to multidisciplinary teams and practical algorithms at the cross-section of cardiology, pulmonology, and primary care.36 Detailing collaborative responsibilities, criteria for urgent referral and frequency of visits could enhance identification and management of CP risk in COPD care. Moreover, advocacy for further data sharing, improved access to electronic healthcare records, utilization of technology to assist better workstream efficiencies (eg, improve coding and billing processes to reduce resource use), and remote care/resources may help bridge the gaps between siloed care and allow for a more integrative approach.36 Integration within the hospital setting is critical, as these high-risk patients often require co-management. Optimizing referral pathways across intensive care, pulmonary, and cardiac consultants supported by evolving algorithms may support inpatient management for COPD patients with exacerbations, chest pain, or stable CVD. Early communication and risk recognition could enable proactive management, potentially reducing complications and unnecessary hospitalization. Primary care should be encouraged to take on a greater responsibility for co-managing COPD and CP risk, extending beyond diagnosis to include ongoing lung function monitoring and broader adoption of spirometry to track progression and enable earlier intervention. Additionally, primary care teams encompassing care coordinators, primary care physicians, and nursing or support staff, should be supported to oversee their patients’ hospital course and transition from the hospital, while hospitalists are encouraged to communicate directly when needed. Creating hospital-based care coordinator networks can help link inpatient care to outpatient practitioners in real time, with the aim of improving continuity and supporting a population health approach. Cardiac engagement should be prioritized, with systematic assessment of cardiac function, ischemic burden, rhythm disturbances, and right-heart function/volume status, as these factors may influence recovery.37,38

Similarly, in outpatient settings, collaborative management among pulmonology, cardiology, and primary care can further support efforts to reduce decompensation and hospitalization, providing substantial patient and economic benefits.

Practical Considerations for CP Risk Management

Based on the gaps and future opportunities for CP risk management discussed, considerations for clinical practices that can be applied to achieve actionable change in CP management are outlined below, in no particular sequence, and presented in Figure 2. These considerations reflect the collective expert opinion of a dedicated Task Force, reached through a structured consensus gathering activity, rather than evidence-based recommendations. The overarching aim is to support CP risk reduction through proactive approaches, including preventative measures and earlier guideline-directed therapies, as well as to encourage collaboration among multidisciplinary teams and specialists.

Figure 2.

A figure outlining gaps in care, actions and target outcomes for CP risk management. The figure presents three columns: Gap in care, Actions and Target outcomes, and three rows, each representing one gap in care along with its corresponding actions and target outcome. Under ′Lack of awareness′, actions include encouraging societies to provide guidelines on cardiopulmonary risk post-AECOPD and organizing meetings on cardiopulmonary risk. The target outcome is increased discussions and renewed guidelines. For ′Lack of evidence-based guidelines for cardiopulmonary risk management′, actions involve conducting clinical research on AECOPD and cardiovascular risk and research on subclinical cardiovascular disease screening. The target outcome is the availability of evidence for cardiopulmonary risk management implementation. Under ′Fragmented care′, actions include streamlining emergency medical records and enabling practitioners to access local hospital emergency medical records. The target outcome is increased accessibility of medical records, leading to better integration of care teams and reduced communication breakdown.

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Suggested actions for improving CP risk management in patients with COPD in the US.

Enhancing Awareness of CP Risk

Develop educational tools, communication resources, and awareness campaigns for patients, primary care physicians, cardiologists, and pulmonologists to support improved understanding of CP risk and potentially support adherence to care pathways. Pulmonary and primary care practitioner societies could play a key role in developing guidelines on the care of COPD patients to include prevention, treatment, and risk reduction following an event/exacerbation.

Structured Screening and Risk Assessment

Implement formal protocols and algorithms for screening, CV risk assessment, and coordinated multidisciplinary care to standardize practice across settings. Due to the higher risk of CV events in the first 30 days of an acute exacerbation,39 patients should have risk factors assessed and any comorbidities (eg, hypertension, dyslipidemia, obesity, hyperglycemia) better outlined and addressed by primary care practitioners and pulmonary practitioners. Furthermore, “at risk” calculators may consider incorporating history of COPD. Subsequent interventions for reducing AECOPD should be investigated in clinical trials to identify appropriate management strategies that may help reduce the risk in this population. Validated questionnaires, such as the COPD Assessment Test (CAT)40 and the Modified Medical Research Council (mMRC)41 dyspnea scale, should be routinely utilized so that patients can be risk-stratified earlier in their care pathway. Implementation of other risk stratification tools, such as the Fibrosis-4 (FIB-4) index for fatty liver disease42,43 and 2023 American Heart Association (AHA) Predicting Risk of Cardiovascular Disease Events (PREVENT)44 calculator could potentially assist in quickly and proactively identifying patients at risk of exacerbations and CV events, respectively. Among patients recommended to receive annual low-dose chest computed tomography (LDCT) to diagnose lung cancer, LDCT scans can be leveraged to identify coronary artery calcification, a predictive risk factor for CV events.20,45 To remain proactive in preventing potential events and reducing decompensation risk, communication of risk assessments from non-pulmonary clinicians should be conveyed to the pulmonary management team. Cardiologists caring for patients with COPD should prioritize systematic assessment of cardiac function (such as RV function, diastology, strain, right-sided pressure) and additional risk factors or symptoms of arrhythmia (event recorders, implantable loop recorders), while also considering smoking and debilitation history.

Routine Lung Function Monitoring

Primary care practitioners and pulmonologists should adopt broader and regular use of spirometry and user-friendly FEV1 tracking devices with the aim of detecting early declines, supporting proactive intervention, and guiding the integrated management of patients with COPD. To overcome some of the barriers associated with routine spirometry use, establishing shared spirometry use sites could be beneficial if approved by a pulmonologist, simplifying patient care and reducing the number of appointments for lung function testing. Due to the chronic nature of COPD, it is critical that patients be seen at regular intervals to monitor and address the progression of the disease.

Vaccinations and Preventive Strategies

Ensure timely vaccinations as part of proactive COPD care and maintain accurate vaccination records to support coordinated care and adherence to the recommended vaccine schedule. Routine spirometry can be combined with CV risk assessment and trend monitoring to support early CP risk reduction and potentially prevent exacerbations. Another key preventative aspect would be to review medication adherence to better understand how patients are using medications.

Earlier Optimization of COPD Disease Management

This management can be facilitated by either the primary care practitioner or pulmonologist responsible for the patient’s care. Implementing clinical guidance on recommended interventions earlier in the care pathway may help reduce the risk of COPD exacerbations (such as smoking cessation, initiating pulmonary rehabilitation, or combination triple therapy). For example, adopting a shared decision-making approach between the prescriber and the patient is encouraged when selecting the appropriate inhaler device.20 Once a device has been selected, prescribers should avoid switching inhaler devices on the basis of non-clinical justifications as it may lead to increased prednisolone use and higher healthcare utilization.20 Development of stronger advocacy tools and policy engagement strategies to help address unnecessary formulary-driven medication changes and burdensome utilization review requirements that can disrupt continuity of COPD care and delay access to appropriate therapies. Additional research on the pharmacology and contemporary management of patients with COPD who are at risk of CV events is needed to better understand the implications of escalating care for these patients.20

Multidisciplinary Team Engagement

Leverage the full healthcare team, including advanced practitioners, nurse practitioners, physicians, and support staff to manage patients with frequent exacerbations and enhance communication across disciplines. While the response should be considered for implementation by every stakeholder in the system, primary care practitioners are often well-positioned to act as the focal point of care coordination, with responsibility for their patients’ course throughout the hospital setting. Establishing care coordination teams for optimal communication between primary care practitioners, patients, and advanced practitioners may assist primary care practitioners with the complex nature of COPD management and AECOPD risk mitigation.

Hospital-Based Integration and Care Coordination

Build referral pathways across intensive care, pulmonary, and cardiac teams to optimize patient care and therapy management. Establish hospital-based care coordinator networks that link inpatient and outpatient care to facilitate timely communication and continuity of care, including clinical pathways that formalize post-discharge follow-up and referral criteria. Advocate for electronic health record access (including providers’ contact information and further clinical assessment or testing necessary), data sharing, remote care resources, and practical algorithms to bridge gaps between compartmentalized services and potentially improve population-level outcomes.

Successful implementation of multidisciplinary CP risk management strategies in COPD within the US healthcare system will require thoughtful navigation of workforce considerations, reimbursement structures, health information system integration, and geographic variation in specialty access. Rural and under-resourced healthcare settings in particular stand to benefit from tailored models that account for care transition infrastructure, shared spirometry resources, and integrated pulmonary-cardiology programs, with due consideration of staffing, transportation, and financial sustainability. Telehealth, remote monitoring, and expanded roles for respiratory therapists and allied health professionals represent promising avenues for broadening access by providing inhaler technique training, education on importance of regular medication use and earlier recognition of exacerbations. However, evidence indicates that such approaches may be constrained in practice by infrastructure requirements, variability in system readiness, and implementation costs, while access to services such as pulmonary rehabilitation remains uneven due to capacity and geographic barriers.46,47

Several important areas need dedicated attention in future work. While the recommendations presented here establish a clinician-driven framework for CP risk assessment and management, translating this framework into operational guidance tailored to specific practice settings represents a critical next step. Future efforts should focus on the development of implementation tools, such as clinical decision support resources, care pathways, and practice-level checklists, that allow the recommendations to be adapted to the varying infrastructures of academic medical centers, community-based practices, and resource-limited settings. While the expert Task Force was intentionally limited to clinicians with direct expertise in COPD and CV comorbidity management for the development of a clinician-led framework for CP risk assessment and management, engagement of a broader stakeholder group, including advanced practice providers, respiratory therapists, pharmacists, payers, care coordinators, and patient advocacy representatives, will also be essential to ensure that future guidance is both practically implementable and patient-centered. Additionally, prospective evaluation of the clinical and economic impact of applying this framework in real-world settings would help to validate and refine these recommendations over time. Taken together, these efforts are intended to strengthen the translational impact of the current work and support the pursuit of meaningful, measurable improvements in CP risk management across diverse care environments.

Conclusions

This consensus paper outlines the key issues and preliminary steps that may potentially help address the significant burden that COPD places on patients, healthcare personnel, and communities across the country. By raising awareness of CP risk and supporting the development of clear treatment pathways, as well as encouraging consideration of proactive and coordinated care models that integrate pulmonology, cardiology, and primary care, healthcare professionals can improve early recognition and management of CP risk in COPD. These strategies have the potential to contribute to long-term system-level improvements in integrated care delivery.

Acknowledgments

Amaris provided medical writing assistance and a ‘secretariat’ role to the multidisciplinary Cardiopulmonary Risk Taskforce, which reviewed the manuscript and made suggestions for the authors to consider.

Funding Statement

AstraZeneca funded medical writing support and the “secretariat” role to the multidisciplinary Cardiopulmonary Risk Taskforce. AstraZeneca supported the convening of the Taskforce and the engagement of participating experts. The authors were responsible for the content of the manuscript and the decision to submit it for publication.

Abbreviations

AECOPD, acute exacerbation of chronic obstructive pulmonary disease; AHA, American Heart Association; CAT, COPD assessment test; CDC, US Centers for Disease Control and Prevention; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; CP, cardiopulmonary; CV, cardiovascular; CVD, cardiovascular disease; FEV1, forced expiratory volume in one second; FIB-4; fibrosis-4 index; GOLD, Global Initiative for Chronic Obstructive Lung Disease; HF, heart failure; ICU, intensive care unit; LDCT, low-dose chest computed tomography; mMRC, Modified Medical Research Council; NHANES, National Health and Nutrition Examination Survey; PREVENT, Predicting Risk of Cardiovascular Disease Events; RV, right ventricular; US, United States.

Ethics Approval and Informed Consent

Ethics approval was not required for this study, as it does not involve human participants or sensitive data. Informed consent was obtained from all individuals who participated in the expert panel.

Author Contributions

All authors made significant contributions to the work reported, including the literature review and providing opinions and calls to action; taking part in the drafting, revising, or critical revision of the article; approving the final version to be published; agreeing on the journal to which the article has been submitted; and agreeing to be accountable for all aspects of the work.

Disclosure

Dr. Brunton reports receiving speaker fees from AstraZeneca and advisory board fees from AstraZeneca and Haleon. Dr. Cambier presently receives consultation and research fees from Novo Nordisk, AstraZeneca, and Bristol Myers Squibb. Dr. Marchetti has received research funding from the US National Institutes of Health (NIH), US Department of Defense, American Lung Association, Chiesi, and Boehringer Ingelheim; advisory board fees from AstraZeneca and Verona Pharma; and speaker fees/Honoraria from AstraZeneca. Dr. Solis has received speaker fees from AstraZeneca, Amgen, and Boehringer Ingelheim and Honoraria from Speaker bureau for COPD; Data safety/advisory board participation from Respiratory advisory board panel member, outside the submitted work. The authors report no other conflicts of interest in this work.

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