Management of chronic obstructive pulmonary disease and chronic heart disease in primary health care : Guidelines, patients and comorbidity

Sammanfattning: The overall aim of this compilation thesis was to explore different aspects of the management of patients with chronic obstructive pulmonary disease (COPD) and heart disease in primary health care: guideline adherence in chronic heart failure (CHF) management (I); comparing patients with COPD and heart failure, and factors associated with the pa-tients’ exercise self-efficacy (II); and the influence of comorbid heart disease in COPD over time (III–IV).Materials and methods: Cross-sectional data from primary health care: 155 patients with heart failure (I) and 150 with COPD and/or heart failure (II). Longitudinal data from patients with COPD from 2005 through 2012 (III) and 2019 (IV), based on questionnaires, medical records, and national registers.Results: (I) Over 80% of the heart failure patients had received relevant laboratory tests and echocardiography. Recommended medication was given to most of the patients, but only a few achieved target doses. Contact with a hospital heart failure clinic was associated with better self-care behavior. (II) Patients with COPD or heart failure had similar exercise self-efficacy, symptoms, functional capacity, and health status. Exercise self-efficacy was associated with symptoms, but not with the diag-nosed disease. (III) COPD with comorbid heart disease was associated with a lower health status and higher level of dyspnea but did not accelerate the worsening over time. (IV) Comorbid heart disease was associated with increased hospitalization and mortality, not for respiratory disease, but mainly for cardiovascular and other causes.Conclusions: Adherence to guidelines for CHF in primary health care is suboptimal, particularly regarding medication target dosage and patient education. It seems more relevant to consider the symptom level than the specific diagnosis when forming self-management groups to increase exercise self-efficacy. In COPD management in primary health care, it is important to recognize and treat heart disease.