Optimizing Interdisciplinary Referral Pathways for Chronic Obstructive Pulmonary Disease Management Across Cardiology and Pulmonology Specialties in the Kingdom of Saudi Arabia.

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's healthcare system.