Fisher et al7 report the results of an observational study of 9,748 patients with acute HF hospitalized at 11 medical centers in Massachusetts during 1995, 2000, 2002, and 2004 with follow-up through 2010. They compared patients with HF with and without COPD with respect to baseline characteristics, HF medication use, and all-cause mortality. The investigators identified HF hospitalizations by coding data with confirmation based on Framingham criteria. Patients with both preserved and reduced ejection fraction were included. Comorbid COPD was defined by clinical or radiographic evidence without further details related to pulmonary function testing or COPD medications. Approximately 35% of patients with acute HF had COPD with a stable prevalence over the study. Patients with COPD had more comorbidities such as renal disease, anemia, and atrial fibrillation compared with patients who did not have COPD. Despite increases in the use of β-blockers over time in those with and without COPD, patients with COPD remained comparatively undertreated (58% vs 73% use in 2004). On multivariable analysis, COPD was associated with similar in-hospital and 30-day mortality, but was associated with a 10% increase in 1-year mortality and a 40% increase in 5-year mortality. When comparing patients identified in 1995 to those from 2004, long-term outcomes improved over time in both groups. However, the magnitude of the survival improvement was greater in patients without COPD.