{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T20:11:36Z","timestamp":1778184696268,"version":"3.51.4"},"reference-count":65,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AstraZeneca"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition with significant economic burden, morbidity, and mortality rates worldwide. In the Kingdom of Saudi Arabia (KSA), 4.2% of adults 40 years and older have COPD, with a higher prevalence in men and older populations. Key risk factors include smoking, air pollution, occupational exposures, and genetics. COPD coexists with cardiovascular disease (CVD) often, making diagnosis and management more difficult. This study proposes two referral algorithms to optimize care for COPD patients with coexisting CVD in the KSA. Methods: A nine-member cardiopulmonary task force reviewed pertinent literature, guidelines, and held virtual meetings from April to August 2025. Every algorithmic component was iteratively refined; consensus was reached when at least 80% of participants agreed, and items not reaching this threshold were revised until full agreement was reached. Results: According to the cardiology-to-pulmonology algorithm, patients who have unidentified respiratory symptoms or COPD risk factors undergo spirometry assessment and, if confirmed, are referred to pulmonology for diagnostic confirmation, phenotyping, and treatment, including triple fixed-dose combination therapy (TFDC) when necessary. On the other hand, the pulmonology-to-cardiology algorithm directs the evaluation of CVD risk factors and comorbidities using clinical evaluation, electrocardiogram, echocardiography, and biomarker testing, for cardiology referral. Conclusions: By establishing bidirectional referral pathways, morbidity and healthcare burden can be decreased, early detection can be improved, and multidisciplinary management can be strengthened. Future research should assess the feasibility, cost-effectiveness, and real-world impact within KSA\u2019s healthcare system.<\/jats:p>","DOI":"10.3390\/jcm14248865","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:57:24Z","timestamp":1765879044000},"page":"8865","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimizing Interdisciplinary Referral Pathways for Chronic Obstructive Pulmonary Disease Management Across Cardiology and Pulmonology Specialties in the Kingdom of Saudi Arabia"],"prefix":"10.3390","volume":"14","author":[{"given":"Majdy M.","family":"Idrees","sequence":"first","affiliation":[{"name":"Division of Pulmonary Medicine, Department of Medicine, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh 11159, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8042-6428","authenticated-orcid":false,"given":"Yahya Z.","family":"Habis","sequence":"additional","affiliation":[{"name":"Pulmonology Division, Department of Internal Medicine, Faculty of Medicine, Saudi Arabia & King Abdulaziz University Hospital, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Jelaidan","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center, College of Medicine\u2014Western Region, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah 21423, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5719-3814","authenticated-orcid":false,"given":"Waleed","family":"Alsowayan","sequence":"additional","affiliation":[{"name":"Security Forces Hospital Program, Division of Pulmonary Medicine, Department of Medicine, P.O. Box 3643, Riyadh 11481, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osama","family":"Almogbel","sequence":"additional","affiliation":[{"name":"Cardiac Sciences Department, King Fahad Cardiac Center, King Saud University, P.O. Box 7805, Riyadh 11472, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdalla M.","family":"Alasiri","sequence":"additional","affiliation":[{"name":"Respiratory and Tuberculosis Unit, Pulmonary Medicine, Ministry of Health, Abha 62522, Aseer Province, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faisal","family":"Al-Ghamdi","sequence":"additional","affiliation":[{"name":"King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abeer","family":"Bakhsh","sequence":"additional","affiliation":[{"name":"King Abdullah Medical City, P.O. Box 57657, Makkah 21955, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0100-6063","authenticated-orcid":false,"given":"Faris","family":"Alhejaili","sequence":"additional","affiliation":[{"name":"Pulmonology Division, Department of Medicine, Saudi Arabia & King Abdulaziz University Hospital, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref_1","unstructured":"(2025). 2024, 2025 Global Initiative for Chronic Obstructive Lung Disease, Chronic Obstructive Lung Disease\u2013GOLD. Available online: https:\/\/goldcopd.org\/2025-gold-report\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12931-024-03051-2","article-title":"Global, regional, and national burden of chronic obstructive pulmonary disease and its attributable risk factors from 1990 to 2021: An analysis for the global burden of disease study 2021","volume":"26","author":"Wang","year":"2025","journal-title":"Respir Res"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1016\/S0954-6111(12)70012-4","article-title":"Distribution of COPD-related symptoms in the Middle East and North Africa: Results of the BREATHE Study","volume":"106","author":"Tageldin","year":"2012","journal-title":"Respir. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/atm.atm_155_24","article-title":"The Saudi Thoracic Society evidence-based guidelines for the diagnosis and management of chronic obstructive pulmonary disease","volume":"20","author":"Lababidi","year":"2025","journal-title":"Ann. Thorac. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ruan, H., Zhao, H., Wang, J., Zhang, H., and Li, J. (2023). All-cause readmission rate and risk factors of 30- and 90-day after discharge in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Ther Adv Respir Dis, 17.","DOI":"10.1177\/17534666231202742"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e1183","DOI":"10.1016\/S2214-109X(23)00217-6","article-title":"The Global Economic Burden of Chronic Obstructive Pulmonary Disease for 204 Countries and Territories in 2020\u20132050: A Health-Augmented Macroeconomic Modelling Study","volume":"11","author":"Chen","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"ref_7","unstructured":"World Health Organization (2024). Chronic Obstructive Pulmonary Disease (COPD), World Health Organization. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/chronic-obstructive-pulmonary-disease-(copd)."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/s12931-022-02242-z","article-title":"The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990\u20132019","volume":"23","author":"Feizi","year":"2022","journal-title":"Respir. Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Alqahtani, J.S. (2022). Prevalence, incidence, morbidity, and mortality rates of COPD in Saudi Arabia: Trends in burden of COPD from 1990 to 2019. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0268772"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1080\/13696998.2021.1945242","article-title":"The impact of seven major noncommunicable diseases on direct medical costs, absenteeism, and presenteeism in Gulf Cooperation Council countries","volume":"24","author":"Finkelstein","year":"2021","journal-title":"J. Med. Econ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"296","DOI":"10.26719\/emhj\/22.015","article-title":"Impact of noncommunicable diseases on direct medical costs and worker productivity, Saudi Arabia","volume":"28","author":"Malkin","year":"2022","journal-title":"East. Mediterr. Health J."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Boettiger, D.C., Lin, T.K., Almansour, M., Hamza, M.M., Alsukait, R., Herbst, C.H., Altheyab, N., Afghani, A., and Kattan, F. (2023). Projected impact of population aging on non-communicable disease burden and costs in the Kingdom of Saudi Arabia, 2020\u20132030. BMC Health Serv Res, 23.","DOI":"10.1186\/s12913-023-10309-w"},{"key":"ref_13","unstructured":"Federation of International Pharmacists (FIP) (2025, August 15). The state of COPD in Saudi Arabia. Available online: https:\/\/ncd.fip.org\/wp-content\/uploads\/2024\/09\/The-state-of-COPD-in-Saudi-Arabia.pdf."},{"key":"ref_14","unstructured":"World Health Organization (2017). The Investment Case for Noncommunicable Disease Prevention and Control in the Kingdom of Saudi Arabia [Internet], WHO and UNDP. Available online: https:\/\/files.acquia.undp.org\/public\/migration\/sa\/180326-MOH-KSA-NCDs-2017.pdf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S2213-2600(21)00511-7","article-title":"Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: A systematic review and modelling analysis","volume":"10","author":"Adeloye","year":"2022","journal-title":"Lancet Respir. Med."},{"key":"ref_16","unstructured":"World Health Organization (2023). Smoking Is the Leading Cause of Chronic Obstructive Pulmonary Disease, WHO. Available online: https:\/\/www.who.int\/news\/item\/15-11-2023-smoking-is-the-leading-cause-of-chronic-obstructive-pulmonary-disease."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8332","DOI":"10.18332\/tid\/202350","article-title":"Comparative Assessment of Respiratory, Hematological and Inflammatory Profiles of Long-Term Users of Cigarettes, Shisha, and e-Cigarettes in Saudi Arabia","volume":"23","author":"Homoud","year":"2025","journal-title":"Tob. Induc. Dis."},{"key":"ref_18","first-page":"7887","article-title":"Investigating the Association between Vape Use and Respiratory Symptoms in Adults in Riyadh, Saudi Arabia. Egypt","volume":"93","author":"Alhaqbani","year":"2023","journal-title":"J. Hosp. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"144","DOI":"10.4103\/atm.ATM_293_17","article-title":"Factors Influencing Management of Chronic Respiratory Diseases in General and Chronic Obstructive Pulmonary Disease in Particular in Saudi Arabia: An Overview","volume":"13","author":"Alsubaiei","year":"2018","journal-title":"Ann. Thorac. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Alqahtani, J.S., Aldhahir, A.M., Siraj, R.A., Alqarni, A.A., AlDraiwiesh, I.A., AlAnazi, A.F., Alamri, A.H., Bajahlan, R.S., Hakami, A.A., and Alghamdi, S.M. (2023). A Nationwide Survey of Public COPD Knowledge and Awareness in Saudi Arabia: A Population-Based Survey of 15,000 Adults. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0287565"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1080\/17476348.2021.1840982","article-title":"Advances in Understanding of Mechanisms Related to Increased Cardiovascular Risk in COPD","volume":"15","author":"Rogliani","year":"2021","journal-title":"Expert. Rev. Respir. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Mikl\u00f3s, Z., and Horv\u00e1th, I. (2023). The Role of Oxidative Stress and Antioxidants in Cardiovascular Comorbidities in COPD. Antioxidants, 12.","DOI":"10.20944\/preprints202305.0028.v1"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1513\/AnnalsATS.202107-823OC","article-title":"Differences in Outcomes between Heart Failure Phenotypes in Patients with Coexistent Chronic Obstructive Pulmonary Disease: A Cohort Study","volume":"19","author":"Gulea","year":"2022","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e002837","DOI":"10.1136\/openhrt-2024-002837","article-title":"Right Ventricular Strain Impairment Due to Hypoxia in Patients with COPD: A Post Hoc Analysis of Two Randomized Controlled Trials","volume":"12","author":"Preiss","year":"2025","journal-title":"Open Heart"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1007\/s12325-024-02855-4","article-title":"Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review","volume":"41","author":"Singh","year":"2024","journal-title":"Adv. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"S\u00e1-Sousa, A., Rodrigues, C., J\u00e1come, C., Cardoso, J., Fortuna, I., Guimar\u00e3es, M., Pinto, P., Sarmento, P.M., and Baptista, R. (2024). Cardiovascular Risk in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13175173"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/clc.20751","article-title":"Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome","volume":"33","author":"Hadi","year":"2010","journal-title":"Clin. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e002153","DOI":"10.1136\/bmjresp-2023-002153","article-title":"Elucidating the Risk of Cardiopulmonary Consequences of an Exacerbation of COPD: Results of the EXACOS-CV Study in Germany","volume":"11","author":"Vogelmeier","year":"2024","journal-title":"BMJ Open Respir. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.recesp.2024.06.004","article-title":"Risk of Severe Cardiovascular Events Following COPD Exacerbations: Results from the EXACOS-CV Study in Spain","volume":"78","author":"Santos","year":"2025","journal-title":"Rev. Espa\u00f1ola De Cardiol. (Engl. Ed.)"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1901217","DOI":"10.1183\/13993003.01217-2019","article-title":"Trajectory and Mortality of Preserved Ratio Impaired Spirometry: The Rotterdam Study","volume":"55","author":"Wijnant","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rapsomaniki, E., Hughes, R., Make, B., Del Olmo, R., Papi, A., Price, D., Belton, L., Franzen, S., Vestbo, J., and M\u00fcllerov\u00e1, H. (2023). Long-Term Outcomes in Patients with Pre-COPD or PRISm in NOVELTY. Monitoring Airway Disease, European Respiratory Society.","DOI":"10.1183\/13993003.congress-2023.OA4936"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/S0140-6736(22)01273-9","article-title":"Towards the Elimination of Chronic Obstructive Pulmonary Disease: A Lancet Commission","volume":"400","author":"Stolz","year":"2022","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e13887","DOI":"10.1111\/eci.13887","article-title":"Association between right ventricular dysfunction and adverse cardiac events in mild COPD patients","volume":"53","author":"Armentaro","year":"2023","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1002\/ejhf.3000","article-title":"Heart failure, chronic obstructive pulmonary disease, and efficacy and safety of dapagliflozin in heart failure with mildly reduced or preserved ejection fraction: Insights from DELIVER","volume":"25","author":"Butt","year":"2023","journal-title":"Eur. J. Heart Fail."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s13011-023-00543-0","article-title":"Awareness and Utilization of Smoking Cessation Clinics in Saudi Arabia, Findings from the 2019 Global Adult Tobacco Survey","volume":"18","author":"Monshi","year":"2023","journal-title":"Subst. Abus. Treat Prev. Policy"},{"key":"ref_36","unstructured":"(2025). 2025, 2026 Global Initiative for Chronic Obstructive Lung Disease, Chronic Obstructive Lung Disease\u2013GOLD. Available online: https:\/\/goldcopd.org\/2026-gold-report-and-pocket-guide\/."},{"key":"ref_37","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","article-title":"2022 ESC\/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension","volume":"43","author":"Humbert","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1164\/rccm.201911-2207OC","article-title":"Reduction in All-Cause Mortality with Fluticasone Furoate\/Umeclidinium\/Vilanterol in Patients with Chronic Obstructive Pulmonary Disease","volume":"201","author":"Lipson","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1164\/rccm.202006-2618OC","article-title":"Reduced All-Cause Mortality in the ETHOS Trial of Budesonide\/Glycopyrrolate\/Formoterol for Chronic Obstructive Pulmonary Disease: A Randomized, Double-Blind, Multicenter, Parallel-Group Study","volume":"203","author":"Martinez","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"233","DOI":"10.7326\/0003-4819-142-4-200502150-00005","article-title":"The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality: A Randomized Clinical Trial","volume":"142","author":"Anthonisen","year":"2005","journal-title":"Ann. Intern. Med."},{"key":"ref_42","first-page":"CD005305","article-title":"Pulmonary Rehabilitation Following Exacerbations of Chronic Obstructive Pulmonary Disease","volume":"10","author":"Puhan","year":"2011","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_43","first-page":"CD005305","article-title":"Pulmonary Rehabilitation Following Exacerbations of Chronic Obstructive Pulmonary Disease","volume":"12","author":"Puhan","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Nocturnal Oxygen Therapy Trial (NOTT) Group (1980). Continuous or Nocturnal Oxygen Therapy in Hypoxemic Chronic Obstructive Lung Disease: A Clinical Trial. Ann. Intern. Med., 93, 391\u2013398.","DOI":"10.7326\/0003-4819-93-3-391"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Medical Research Council (MRC) Working Party (1981). Long-Term Domiciliary Oxygen Therapy in Chronic Hypoxic Cor Pulmonale Complicating Chronic Bronchitis and Emphysema. Lancet, 1, 681\u2013686.","DOI":"10.1016\/S0140-6736(81)91970-X"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S2213-2600(14)70153-5","article-title":"Non-Invasive Positive Pressure Ventilation for the Treatment of Severe Stable Chronic Obstructive Pulmonary Disease: A Prospective, Multicentre, Randomised, Controlled Clinical Trial","volume":"2","author":"Windisch","year":"2014","journal-title":"Lancet Respir. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1056\/NEJMoa030287","article-title":"National Emphysema Treatment Trial Research Group. A Randomized Trial Comparing Lung-Volume-Reduction Surgery with Medical Therapy for Severe Emphysema","volume":"348","author":"Fishman","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Shaphe, M.A., Alshehri, M., Alajam, R.A., Ghazwani, A., Temehy, B.F., Sahely, A., Alfaifi, B.H., Hakamy, A., Khan, A., and Aafreen, A. (2025). Evaluating the physiological responses to treadmill exercise based on the 6-minute walk test in individuals with COPD across severity levels. Front. Physiol., 16.","DOI":"10.3389\/fphys.2025.1668559"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"228","DOI":"10.62464\/ijoprp.v3i5.33","article-title":"Proposed protocol for developing a rehabilitation program for chronic obstructive pulmonary disease patients in Saudi Arabia","volume":"3","author":"Alshammri","year":"2024","journal-title":"Int. J. Phys. Ther. Res. Pract."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Alahmadi, F.H. (2025). Optimizing Pulmonary Rehabilitation in Saudi Arabia: Current Practices, Challenges, and Future Directions. Medicina, 61.","DOI":"10.3390\/medicina61040673"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1183\/20734735.0354-2018","article-title":"Use of the Terms \u201cOverdiagnosis\u201d and \u201cMisdiagnosis\u201d in the COPD Literature: A Rapid Review","volume":"15","author":"Thomas","year":"2019","journal-title":"Breathe"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.jchf.2019.05.009","article-title":"Diagnostic and Therapeutic Gaps in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease","volume":"7","author":"Canepa","year":"2019","journal-title":"JACC Heart Fail."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"148","DOI":"10.37616\/2212-5043.1336","article-title":"Cardiovascular Disease in Saudi Arabia: Facts and the Way Forward","volume":"35","author":"Tash","year":"2023","journal-title":"J. Saudi Heart Assoc."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Aljerian, N.A., Alharbi, A.A., AlOmar, R.S., Binhotan, M.S., Alghamdi, H.A., Arafat, M.S., Aldhabib, A., and Alabdulaali, M.K. (2024). Showcasing the Saudi E-Referral System Experience: The Epidemiology and Pattern of Referrals Utilising Nationwide Secondary Data. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1348442"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Shehab, A., Alzaabi, A., Al Zubaidi, A., Mahboub, B., Skouri, H., Alhameli, H., El-Tamimi, H., and Iqbal, M.N. (2025). Streamlining Referrals by Establishing a UAE-Specific Referral Algorithm for CVD Patients with Overlapping COPD: A Collaborative Effort by Cardiologists and Pulmonologists. Front Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1531966"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.2147\/COPD.S523865","article-title":"Chronic Obstructive Pulmonary Disease and the Management of Cardiopulmonary Risk in the UK: A Systematic Literature Review and Modified Delphi Study","volume":"20","author":"Shrikrishna","year":"2025","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"zwaf119","DOI":"10.1093\/eurjpc\/zwaf119","article-title":"Identification and Management of Cardiopulmonary Risk in Patients with Chronic Obstructive Pulmonary Disease","volume":"32","author":"Gale","year":"2025","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Di Chiara, C., Sartori, G., Fantin, A., Castaldo, N., and Crisafulli, E. (2025). Reducing Hospital Readmissions in Chronic Obstructive Pulmonary Disease Patients: Current Treatments and Preventive Strategies. Med. (B Aires), 61.","DOI":"10.3390\/medicina61010097"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"k4388","DOI":"10.1136\/bmj.k4388","article-title":"Triple Therapy in the Management of Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis","volume":"363","author":"Zheng","year":"2018","journal-title":"BMJ"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.arbres.2024.01.013","article-title":"Multidisciplinary Management of Patients With Chronic Obstructive Pulmonary Disease and Cardiovascular Disease","volume":"60","year":"2024","journal-title":"Arch. Bronconeumol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.chest.2019.04.099","article-title":"Collaborative Cardiology and Pulmonary Management of Pulmonary Hypertension","volume":"156","author":"Fernandes","year":"2019","journal-title":"Chest"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Au-Doung, P.L.W., Wong, C.K.M., Chan, D.C.C., Chung, J.W.H., Wong, S.Y.S., and Leung, M.K.W. (2022). PUMA Screening Tool to Detect COPD in High-Risk Patients in Chinese Primary Care\u2013A Validation Study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0274106"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.arbres.2024.06.013","article-title":"The Accuracy of PUMA Questionnaire in Combination With Peak Expiratory Flow Rate to Identify At-Risk, Undiagnosed COPD Patients","volume":"60","author":"Su","year":"2024","journal-title":"Arch. Bronconeumol."},{"key":"ref_64","unstructured":"World Health Organization (2021). Global Strategy on Digital Health 2020\u20132025, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/344249."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e44065","DOI":"10.2196\/44065","article-title":"Integrating Clinical Decision Support Into Electronic Health Record Systems Using a Novel Platform (EvidencePoint): Developmental Study","volume":"7","author":"Solomon","year":"2023","journal-title":"JMIR Form. 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