Abstract
Background: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are highly prevalent chronic conditions that frequently coexist and share common risk factors, including smoking, aging, and physical inactivity. COPD is associated with a two- to fivefold increased risk of HF, yet estimates of COPD prevalence among HF patients vary widely, and the impact of this coexistence on morbidity and mortality remains uncertain. Reliable long-term, real-world data—particularly from the Gulf region—are limited. This systematic review and meta-analysis aimed to evaluate the relationship between COPD and HF and to assess the impact of their coexistence on clinical outcomes.
Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Major electronic databases (PubMed, EMBASE, Cochrane Library, and Scopus) were searched for studies published in English involving adults (≥18 years) with both COPD and HF. Observational studies and randomized controlled trials reporting morbidity and/or mortality outcomes were included. Pediatric studies, case reports, editorials, and studies lacking clear diagnostic criteria for COPD or HF were excluded. Data were synthesized qualitatively and quantitatively where applicable.
Results: Ten studies published between 1990 and 2023 were included, encompassing prospective registries, retrospective cohorts, cross-sectional studies, physician surveys, and one meta-analysis, primarily from Saudi Arabia and the Gulf region [4–13]. COPD prevalence among HF patients was approximately 10% in acute HF cohorts, while primary-care screening revealed a COPD prevalence of 14.2% among smokers aged ≥40 years, indicating substantial underdiagnosis [4,13]. Patients with COPD–HF overlap were generally older and had higher rates of cardiometabolic and systemic comorbidities. COPD was associated with increased hospital length of stay, ICU admission (12.4%), and higher 30- and 90-day readmission rates (up to 39%) [5,6,12]. However, COPD was not independently associated with increased in-hospital or one-year mortality in acute HF populations [4]. Subclinical cardiac dysfunction was frequently observed in COPD patients and was not correlated with airflow limitation severity [7].
Conclusion: COPD and heart failure commonly coexist and significantly increase healthcare utilization, ICU admission, and hospital readmissions in the Gulf region. Although COPD does not independently increase short-term mortality in heart-failure populations, it substantially contributes to morbidity and post-discharge burden. Rising COPD prevalence, persistent underdiagnosis, and variability in multidisciplinary management highlight the need for early detection, integrated cardiopulmonary care models, and targeted interventions to reduce readmissions and improve outcomes.

Key words: COPD, Heart Failure, Coexistence , comorbidity