Risk of Cardiovascular Events According to the Severity of an Exacerbation of Chronic Obstructive Pulmonary Disease.

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

Methods: A case-crossover study was conducted using the French exhaustive hospital discharge database (2013-2019). Case-patients had a diagnosis of COPD, hospitalised for a CVE in France in 2018-2019 (admission date was index date) with no other CVE in ≤12 months, and had ≥1 hospitalisation for exCOPD ≤24 weeks before index CVE. The key exposure was hospitalisation for exCOPD (overall and according to levels of care intensity) ≤1-4 weeks versus 9-24 weeks preceding the CVE. Conditional logistic regression models estimated odds ratios (OR) for the association between hospitalisation for exCOPD and different types of CVE.

Results: Among 9,840 case-patients, the most frequent CVE was decompensated heart failure (5,888 case-patients, 59.8%). The CVE risk was greater ≤4 weeks after a hospitalisation for any exCOPD (OR, 3.03; 95% confidence interval [CI], 2.90-3.16) and 7 times greater if mechanical ventilation was necessary (OR, 6.99; 95% CI, 6.09-8.03). The risk of NSTEMI (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 CVE: STEMI (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 (1.34). Ten percent of CVE were fatal.

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