Risk of cardiovascular events according to the severity of an exacerbation of chronic obstructive pulmonary disease

Abstract

Aims: Risk estimation of different types of cardiovascular events (CVEs) following a hospitalization for exacerbated chronic obstructive pulmonary disease (exCOPD) is warranted to consider prevention.

Methods and results: A case-crossover study was conducted using the French exhaustive hospital discharge database (2013-19). Case-patients had a diagnosis of chronic obstructive pulmonary disease, were hospitalized for a CVE in France in 2018-19 (admission date was index date) with no other CVE in ≤12 months, and had ≥1 hospitalization for exCOPD ≤24 weeks before index CVE. The key exposure was hospitalization for exCOPD (overall and according to levels of care intensity) ≤1-4 weeks vs. 9-24 weeks preceding the CVE. Conditional logistic regression models estimated odds ratios (ORs) for the association between hospitalization for exCOPD and different types of CVE. Among 9840 case-patients, the most frequent CVE was decompensated heart failure (5888 case-patients, 59.8%). The CVE risk was greater ≤4 weeks after a hospitalization for any exCOPD [OR, 3.03; 95% confidence interval (CI), 2.90-3.16] and seven times greater if mechanical ventilation was necessary (OR, 6.99; 95% CI, 6.09-8.03). The risk of non-ST-elevation myocardial infarction (OR, 5.33; 95% CI, 4.47-6.34) was the highest among CVE. The risk was also significantly increased (P <0.05) for many other CVEs: ST-elevation myocardial infarction (OR, 4.24), resuscitated cardiac arrest (OR, 4.33), pulmonary embolism (OR, 4.02), atrial fibrillation/flutter (OR, 3.03), ischaemic stroke (OR, 1.93), and limb events (OR, 1.34). Ten percent of CVEs were fatal.

Conclusion: Following hospitalization for exCOPD, the risk of cardiovascular complications is increased. These patients require close and sustained monitoring to mitigate CVE risk.

Keywords: Cardiovascular events; Case-crossover study; Chronic obstructive pulmonary disorder.