Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with an increased risk for all-cause death and hospitalization for acute coronary syndrome (ACS), heart failure (HF) decompensation, arrhythmia, and cerebral ischemia, researchers reported in Heart.
Researchers explored whether COPD exacerbations were linked to a subsequent risk for adverse cardiovascular (CV) events, conducting an observational retrospective cohort study using data from the Alberta Health’s COPD chronic disease cohort from April 1, 2014, to March 31, 2019. The primary outcome was a composite of all-cause mortality and first hospitalization for ACS, HF decompensation, arrhythmia, or cerebral ischemia, all occurring after a moderate or severe COPD exacerbation.
The study cohort included 142,787 individuals with COPD (mean [SD] age at cohort entry, 68.1 [12.3] years; 52% male). Upon entering the cohort, participants were at least 40 years of age, were residents of Alberta, had at least 24 months of pre-cohort entry data available for analysis, and did not have COPD related to alpha-1 antitrypsin deficiency. Follow-up continued until either: the first occurrence of the primary outcome; the participant moved out of Alberta; or administrative censoring on March 31, 2020.
After a median follow-up of 64 months (interquartile range, 35-72), 61,981 (43.4%) patients had at least 1 exacerbation of any severity. About one-fourth (23.9%) of patients died, and 29.7% of those deaths were cardiac related.
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These findings can help health care professionals identify patients at risk of CV events or death, to initiate timely preventive care and monitoring, reduce the risk of first and future exacerbations, and improve patient outcomes.
The primary outcome was observed in 43,564 (30.5%) patients with an incidence rate before exacerbation of 5.43 (95% CI, 5.36-5.50) per 100 person-years, which increased to 95.61 per 100 person-years 1 to 7 days postexacerbation (adjusted hazard ratio [HR],15.86; 95% CI, 15.17-16.58).
The risk decreased over time but was significant beyond 1-year postexacerbation onset (incidence rate 7.35; 95% CI, 7.16-7.55; HR, 1.08; 95% CI, 1.05-1.12). The risk for the composite outcome increased after a moderate or severe exacerbation, with a greater and more prolonged association occurring after a severe exacerbation.
The risk for the individual types of severe CV events increased significantly after onset of an exacerbation of any severity. The adverse outcome risk was especially increased for HF decompensation compared with the other CV outcomes in the first 6 months post exacerbation. The incidence rate for HF decompensation before a first exacerbation was 0.56 (95% CI, 0.53-0.58) per 100 person-years, which increased to 21.45 (95% CI, 20.07-22.90) at 1 to 7 days post exacerbation (adjusted HR, 72.34; 95% CI, 64.43-81.22). The rate was significantly increased at 31 to 180 days (incidence rate 0.68; 95% CI, 0.61-0.76; adjusted HR, 2.25; 95% CI, 1.96-2.59).
Among several study limitations, the accuracy and reporting of medical codes in claims databases can vary, and behavioral risk factors such as smoking, diet, alcohol consumption, and body weight were not included in the database. In addition, unmeasured confounding may have led to overestimating the strength of the association.
“These findings can help health care professionals identify patients at risk of CV events or death, to initiate timely preventive care and monitoring, reduce the risk of first and future exacerbations, and improve patient outcomes,” the investigators stated.
Disclosure: This research was funded by AstraZeneca UK. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
