Chronic obstructive pulmonary disease and comorbidities in heart failure: the next frontier of sodium–glucose co‐transporter 2 inhibitors?

B This article refers to 'Effects of dapagliflozin in heart failure with reduced ejection fraction, and chronic obstructive pulmonary disease: an analysis of DAPA-HF' by P. Dewan I et al i ., published in this issue on pages 632-643. b The term "comorbidity" is used to identify cardiovascular and non-cardiovascular diseases that are present in patients with heart failure (HF), interfere with care and impair outcomes. GLO:P3O/01apr21:ejhf2109-fig-0001.jpg PHOTO (COLOR): 1 Diagnostic and therapeutic management of heart failure with reduced ejection fraction (HFrEF) patients with chronic obstructive pulmonary disease (COPD) and effects of sodium-glucose co-transporter 2 inhibitors (SGLT2-i). In several previous HF trials, COPD was assigned only to those patients treated with drugs for COPD,5,7 and about half of the patients (46.3%) with COPD enrolled in the DAPA-HF used at least one form of inhaled therapy.8 However, adherence to and persistence on COPD medications are known to be low, with about half of spirometry-confirmed COPD patients not being able to maintain their initial COPD therapy at 1 year.10 Clearly, the diagnostic inaccuracy and the lack of comorbidity characterization in HFrEF research is driven by trial feasibility and straightforward patient inclusion that can be limited by too complex inclusion criteria. In DAPA-HF, the contribution of infections and other causes to death was greater in COPD than in non-COPD patients, as expected ( I Figure i 1). [Extracted from the article]