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Conclusion and Direction for Future Research
The interaction between the heart and lungs is complex and incompletely understood. As with the kidney, direct physical connection and systemic neurohormonal and inflammatory activation are responsible. Understanding these pathways may yield novel therapies. However, many of the challenges facing physicians and healthcare systems have potential to be addressed through existing resources. Comprehensive large-scale cohort studies and trials are required: establishing the prevalence and clinical consequences of the respective coexistent condition; prospectively testing diagnostic strategies; establishing the efficacy and cost-effectiveness of screening; undertaking randomized controlled trials of beta-blockers and beta-agonists across a spectrum of pulmonary and cardiovascular diseases, respectively; and determining the efficacy of integrated chronic disease management strategies. Such far reaching studies require closer collaboration between the cardiovascular and pulmonary communities. They also require greater financial support from governments, research funders, and healthcare payers. Translational medicine is expensive; so too are the consequences of ignoring the challenges of multimorbidity.
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