Increased risk of severe cardiovascular events following exacerbations of COPD: A multi-database cohort study

Introduction: Risk of severe cardiovascular events (CVE) increases following severe exacerbations of COPD (ECOPD). However, the duration of increased risk and the effect of moderate ECOPD are unclear. Objective: To quantify risk of a severe CVE or death following a moderate or severe ECOPD. Methods: Patients with COPD were identified in secondary databases between 2014–2018 in Canada, Germany, the Netherlands (NL) and Spain and followed until experiencing a composite outcome (death or hospitalisation for acute coronary syndrome, heart failure, arrhythmias or cerebral ischaemia) or censoring. Time-dependent Cox models compared the outcome risk incrementally over 12 months following an ECOPD (exposure) vs periods outside an ECOPD (non-exposure). Results: The proportions of patients with 1+ moderate and 1+ severe ECOPD were respectively 26.6% and 30.2% (Canada), 29.7% and 27.0% (Germany), 23.3% and 9.3% (NL), and 58.6% and 9.5% (Spain). Severe CVE or death occurred in 30.5% (Canada), 38.6% (Germany), 13.7% (NL) and 35.8% (Spain) of patients. In all countries, moderate ECOPD increased the risk of outcome for 1–6 months. Severe ECOPD further augmented risk, which was sustained for >12 months (Table). Conclusion: Patients experience elevated and sustained risk of a severe cardiopulmonary event or death following either moderate, or severe ECOPD, highlighting the urgency for comprehensive clinical management. Funding: AstraZeneca funded this study.