relevant diagnostic investigations-that is, patients in whom treatment is likely to be initiated in everyday practice.In conclusion, several easily obtained clinical parameters and a few additional diagnostic investigationsnotably, natriuretic peptide and electrocardiographymay improve the detection of concomitant heart failure in primary care patients with COPD.The use of these parameters should increase confidence about the diagnosis of heart failure and will help GPs to decide about the need for additional echocardiography or treatment in patients with COPD.We thank the participating patients, general practitioners and their assistants, including the general practices connected to the General Practice Network Utrecht (HNU), the cardiac sonographers Elly Lutgert-Hagman and Ineke Kasteleijn, the pulmonology technicians, especially Paul Munnik, and Pieter Zanen, lung physiologist.Frances Verheij assisted us with the data management.
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Netuveli et al. (2005) studied this question.