Risk of severe cardiovascular events following COPD exacerbations: results from the EXACOS-CV study in Spain

Salud Santos; Nicolás Manito; Joaquín Sánchez-Covisa; Ignacio Hernández; Carmen Corregidor; Luciano Escudero; Kirsty Rhodes; Clementine Nordon

doi:10.1016/j.rec.2024.06.003

Risk of severe cardiovascular events following COPD exacerbations: results from the EXACOS-CV study in Spain

Rev Esp Cardiol (Engl Ed). 2024 Jun 25:S1885-5857(24)00194-4. doi: 10.1016/j.rec.2024.06.003. Online ahead of print.

[Article in English, Spanish]

Authors

Salud Santos¹, Nicolás Manito², Joaquín Sánchez-Covisa³, Ignacio Hernández⁴, Carmen Corregidor⁵, Luciano Escudero⁵, Kirsty Rhodes⁶, Clementine Nordon⁷

Affiliations

¹ Servicio de Neumología, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
² Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
³ Medical Department, Evidence Generation, AstraZeneca, Madrid, Spain. Electronic address: joaquin.sanchez-covisa@astrazeneca.com.
⁴ Atrys Health, HEOR, Madrid, Spain.
⁵ Medical Department, Medical Affairs, AstraZeneca, Madrid, Spain.
⁶ Real World Science & Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom.
⁷ Epidemiology Medical Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom.

PMID: 38936468
DOI: 10.1016/j.rec.2024.06.003

Abstract

Introduction and objectives: This real-world study-the first of its kind in a Spanish population-aimed to explore severe risk for cardiovascular events and all-cause death following exacerbations in a large cohort of patients with chronic obstructive pulmonary disease (COPD).

Methods: We included individuals with a COPD diagnosis code between 2014 and 2018 from the BIG-PAC health care claims database. The primary outcome was a composite of a first severe cardiovascular event (acute coronary syndrome, heart failure decompensation, cerebral ischemia, arrhythmia) or all-cause death following inclusion in the cohort. Time-dependent Cox proportional hazards models estimated HRs for associations between exposed time periods (1-7, 8-14, 15-30, 31-180, 181-365, and >365 days) following an exacerbation of any severity, and following moderate or severe exacerbations separately (vs unexposed time before a first exacerbation following cohort inclusion).

Results: During a median follow-up of 3.03 years, 18 901 of 24 393 patients (77.5%) experienced ≥ 1 moderate/severe exacerbation, and 8741 (35.8%) experienced the primary outcome. The risk of a severe cardiovascular event increased following moderate/severe COPD exacerbation onset vs the unexposed period, with rates being most increased during the first 1 to 7 days following exacerbation onset (HR, 10.10; 95%CI, 9.29-10.97) and remaining increased >365 days after exacerbation onset (HR, 1.65; 95%CI, 1.49-1.82).

Conclusions: The risk of severe cardiovascular events or death increased following moderate/severe exacerbation onset, illustrating the need for proactive multidisciplinary care of patients with COPD to prevent exacerbations and address other cardiovascular risk factors.

Keywords: Agudización; Cardiopulmonar; Cardiopulmonary; Cardiovascular risk; Chronic obstructive pulmonary disease; Enfermedad pulmonar obstructiva crónica; Estudio observacional; Exacerbation; Mortalidad; Mortality; Observational study; Riesgo cardiovascular.