PhD Defence Sanne van Dijk | Symptom dynamics in chronic obstructive pulmonary disease and chronic heart failure | A comprehensive clinical and methodological exploration

Symptom dynamics in chronic obstructive pulmonary disease and chronic heart failure | A comprehensive clinical and methodological exploration

Sanne van Dijk is a PhD student in the department Health Technology & Services Research. (Co)Promotors are prof.dr. C.J.M. Doggen; dr. A. Lenferink and dr. M.G.J. Brusse-Keizer from the faculty Behavioural Management and Social Sciences (BMS), University of Twente.

Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are progressive conditions that often occur together, largely because they share important risk factors such as smoking. Both diseases are characterized by sudden flare-ups of symptoms, called acute exacerbations of COPD (AECOPD) and acute heart failure (AHF). Because symptoms, such as shortness of breath, largely overlap between COPD and CHF, it is difficult to distinguish AECOPDs from AHF. This overlap complicates timely diagnosis and treatment, yet current healthcare systems still manage COPD and CHF mostly in isolation. This thesis examines how these conditions interact, how to differentiate AECOPDs and AHF in the clinic, and how technological innovations can contribute to more personalized and integrated care for people with COPD and CHF.

Using extensive daily symptom data from international cohort studies, this research demonstrates that worsening symptoms of COPD and CHF often occur simultaneously. Although the timing and intensity of symptoms varied considerably between individuals, the overall pattern was clear: COPD and CHF do not behave as separate diseases in daily life. Their symptoms influence each other, underscoring the need for care strategies that reflect the complexity of multimorbidity rather than relying on separate, single-disease guidelines.

A major challenge is accurately distinguishing AECOPD from AHF in real-world settings. A comprehensive review of the scientific literature revealed that only a few biomarkers show some ability to support this distinction, and even these require careful interpretation alongside other clinical information. The limited availability of high-quality evidence found highlights the urgent need for better diagnostic tools to guide clinical decision-making.

The thesis also explores how COPD and CHF symptoms interact over time. Advanced statistical models showed a bidirectional relationship: worsening heart failure symptoms often preceded worsening COPD symptoms the following day, and vice versa. However, these dynamics differed strongly between patients. For many, COPD deterioration appeared to provoke heart failure episodes more often than the reverse. The variety in results between patients illustrate why standardized treatment pathways can fall short and why more individualized approaches are essential.

New technologies offer promising opportunities in this regard. Remote monitoring allowed patients to track their symptoms daily, and visualizations of these patterns helped both patients and healthcare professionals better understand the variations and potential triggers of worsening of symptoms. Interviews with both patients and healthcare professionals form various disciplines revealed that visual tools could support more meaningful conversations, shared decision-making, and personalized self-management strategies.

Overall, this thesis highlights both the complexity and the clinical importance of the COPD-CHF relationship. Overlapping symptoms, patient-specific disease interactions, and the absence of robust diagnostic markers pose significant challenges for effective care. At the same time, technological innovations – such as intensive symptom monitoring and data-driven analytical methods – offer new opportunities to tailor treatment to individual needs. Future research should focus on refining diagnostic strategies, improving integrated care pathways, and leveraging technology to support more patient-centered management for those living with both COPD and CHF.