Actionable Insights Newsletter

Translating research to power whole health

Issue 8    |    March 2024

Patients newly diagnosed with COPD face significant risk of death and cardiovascular events following moderate and severe exacerbations

In one of the first real-world studies of newly diagnosed COPD patients, researchers found an increased risk of death and cardiovascular events that persisted for up to two years following moderate and severe exacerbations and increased with each subsequent exacerbation.

Enterprise Analytics Core domain(s): Cardiometabolic, community health (SDoH), policy guidance

Summary

Background
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are episodes where COPD symptoms quickly and significantly worsen. Patients often need medical care and additional treatment to manage AECOPD.

Objective
To estimate the magnitude and duration of risk of cardiovascular events and death following AECOPD, and whether risks varied by number and severity of exacerbation in commercially insured Americans.

Methods
This was a retrospective cohort study of newly diagnosed COPD patients ≥40 years old in the Healthcare Integrated Research Database from 2012-2019. Patients experiencing exacerbations at any point on or after their COPD diagnosis comprised the “exacerbation cohort.” Patients without a history of exacerbations comprised the “unexposed” cohort. Moderate exacerbations were outpatient visits with an antibiotic or glucocorticoid fill; severe exacerbations were emergency department visits or hospitalizations for AECOPD.

The risks of a cardiovascular event or death (defined using data linked from the National Death Index) following an exacerbation were estimated adjusting for medical and prescription history and stratified by follow-up time, type of cardiovascular event, exacerbation severity, rank of exacerbation (first, second, or third), urbanicity, and neighborhood socioeconomic status (SES).

Results
Among 435,925 patients, 170,236 experienced ≥1 exacerbation. Risk of death was elevated for 2 years (Figure 1) and was highest in the first 30 days following an exacerbation (any exacerbation hazard ratio (HR)=1.79, 95% confidence interval (C)I=1.58—2.04; moderate HR=1.22, 95% CI=1.04—1.43; severe HR=5.09, 95% CI=4.30—6.03) (Figure 2). 

Risks of cardiovascular events were increased for 1 year following an AECOPD and were highest in the first 30-days (any exacerbation HR=1.34, 95% CI=1.23—1.46; moderate HR=1.23 (95% CI 1.12—1.35); severe HR=1.93 (95% CI= 1.67—2.22).

Each subsequent AECOPD was associated with incrementally higher rates of both death and cardiovascular events (Figure 2). Patients living in rural neighborhoods and lower SES neighborhoods were at higher risk of a cardiovascular event and death following an exacerbation.

Figure 1. Hazard ratios (95% CI) of death and acute CV events following AECOPD


Figure 2. Subgroup analyses estimating the hazard of death by severity and number of AECOPD

Key takeaways