Risk for cardiovascular events stays high 1 year after COPD exacerbation

Key takeaways:

• After a COPD exacerbation, patients face a raised risk for cardiovascular events.
• The time linked to the greatest risk for nonfatal cardiovascular events differed based on exacerbation severity.

Among patients with COPD who experienced an exacerbation, the risk for cardiovascular events was highest in the following 2 weeks and stayed elevated more than 1 year after, according to study results.

These findings were published in American Journal of Respiratory and Critical Care Medicine.

“Given the novel finding of sustained [hazard ratios] beyond a year after exacerbation irrespective of exacerbation severity, long-term cardiovascular health should be prioritized in addition to reducing exacerbation events and optimizing COPD management,” Emily L. Graul, MS, a research assistant in epidemiology at Imperial College London at the time of this study, and colleagues wrote. “If we can proactively screen for cardiac state (eg, using echocardiography) in patients with COPD, perhaps we can treat and/or prevent future events.”

Using the Clinical Practice Research Datalink Aurum primary care database, Graul and colleagues assessed 213,466 patients with COPD in England between 2014 and 2020, to find out how the risk for incident, nonfatal hospitalized cardiovascular events changes based on time since COPD exacerbation and exacerbation severity.

Conditions that fell under cardiovascular events included acute coronary syndrome, arrhythmia, heart failure, ischemic stroke and pulmonary hypertension.

A total of 146,448 patients experienced an exacerbation, and a greater number of patients experienced moderate vs. severe exacerbations first (119,124 vs. 27,324).

In terms of cardiovascular events during the median 2.4-year follow-up period, researchers observed 40,773 events. The most common cardiovascular event was arrhythmia (49.3%), followed by heart failure (31.1%), acute coronary syndrome (10.1%), ischemic stroke (5.88%) and pulmonary hypertension (3.66%).

Compared with the cohort without exacerbations, the crude incidence rate of cardiovascular events per 100 person-years was greater in the cohort with exacerbations (8.79 vs. 3.66).

Further, within the cohort of those who experienced an exacerbation, researchers noted a higher incidence rate in the severe vs. moderate exacerbation group (15.7 vs. 7.79 per 100 person-years).

Considering all COPD exacerbations, the risk for nonfatal cardiovascular events was heightened as soon as 1 to 14 days after the exacerbation (adjusted HR = 3.19; 95% CI, 2.71-3.76), and this period had the greatest risks for three individual cardiovascular events: heart failure (aHR = 2.87; 95% CI, 2.36-3.5), arrhythmias (aHR = 2.86; 95% CI, 2.36-3.47) and pulmonary hypertension (aHR= 2.85; 95% CI, 1.57-5.17). As time passed, the risk fell but was still increased after the 1-year mark (aHR = 1.84; 95% CI, 1.78-1.91).

The time linked to the greatest risk for nonfatal cardiovascular events differed based on exacerbation severity. For severe exacerbations, patients faced the greatest risk 1 to 14 days after the exacerbation (aHR = 14.5; 95% CI, 12.2-17.3). More specifically, researchers found elevated risks for arrhythmia (aHR = 12.7; 95% CI, 10.3-15.7) and heart failure (aHR = 8.31; 95% CI, 6.79-10.2) within the 1-to-14-day period after a severe exacerbation.

In contrast, patients who experienced a moderate exacerbation faced the most increased risk for cardiovascular events 14 to 30 days after the exacerbation (aHR = 1.94; 95% CI, 1.63-2.31).

Similar to the analysis that considered all exacerbations, the risk for cardiovascular events after both moderate and severe exacerbations went down after the 1-year mark but was still heightened (moderate, aHR = 1.74; 95% CI, 1.67-1.8; severe, aHR = 2.71; 95% CI, 2.59-2.86).

“Although there is a clear window of opportunity for prompt clinical intervention and treatment optimization after an exacerbation, continued recognition and optimization is important for reducing this long-term cardiopulmonary risk,” Graul and colleagues wrote. “The prevention of COPD exacerbations may ultimately help reduce cardiovascular risk.”