Agreement Between Medical Record–Documented Chronic Obstructive Pulmonary Disease and Post-Bronchodilator Airflow Obstruction in Patients with Heart Failure

Objective: To assess agreement between medical record–documented chronic obstructive pulmonary disease (COPD) and laboratory-reported post-bronchodilator airflow obstruction in patients with heart failure (HF), with exploratory assessment of respiratory comorbidities and spirometry-field consistency. Methods: This retrospective, single-hospital cross-sectional analysis included 200 patients with documented HF during 2021–2025. Medical record–documented COPD was compared with an FEV1/FVC ratio <0.70, using ratios transcribed from official post-bronchodilator pulmonary function reports. Agreement was quantified by observed agreement and Cohen’s kappa. Separately entered FEV1 and FVC volumes were examined in a data-consistency audit. Exploratory subgroup analyses examined asthma, pulmonary fibrosis, and arithmetic-consistent records. Results: COPD was recorded in 113/200 patients (56.5%), and 27/200 (13.5%) met the fixed-ratio obstruction threshold. Fifteen patients met both classifications, 98 had recorded COPD without obstruction, and 12 had obstruction without recorded COPD. Observed agreement was 45.0% and Cohen’s kappa was −0.005 (bootstrap 95% CI, −0.090 to 0.081). The ratio and quotient of separately entered volumes differed by >0.05 in 120/200 records (60.0%). Exploratory subgroup kappa estimates ranged from −0.059 to 0.047. Conclusions: The two recorded classifications showed little agreement beyond chance in this selected HF cohort. The analysis uses laboratory-reported ratios, but the discrepancies with separately entered volume fields and uncertainties in patient selection limit interpretation. These findings do not establish diagnostic error or COPD overdiagnosis.