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The importance of cardiovascular disease for mortality in patients with COPD: a prognostic cohort study
Jing Zhang1, Frans H Rutten, Maarten J Cramer
1Public Helath College, Nantong University, China.
Insights
Cardiovascular disease, particularly angina, significantly predicts mortality in COPD patients. Early detection and treatment of ischemic heart disease are crucial for improving prognosis in individuals with chronic obstructive pulmonary disease.
Area of Science:
- Pulmonology
- Cardiology
- Geriatrics
Background:
- Cardiovascular diseases are a leading cause of death in patients with chronic obstructive pulmonary disease (COPD).
- Existing COPD prediction models often overlook cardiovascular risk factors.
- This study addresses the underestimation of cardiovascular determinants in COPD mortality prediction.
Purpose of the Study:
- To quantify the impact of cardiovascular factors on mortality in patients diagnosed with COPD.
- To identify key predictors of all-cause mortality in an elderly COPD population.
Main Methods:
- Followed 405 patients aged ≥65 years with a COPD diagnosis (244 confirmed by spirometry) for an average of 4.2 years.
- Employed Cox proportional hazard regression analyses with bootstrapping to identify independent predictors of mortality.
- Validated the predictive model in a subgroup meeting GOLD criteria for COPD.
Main Results:
- Age, angina pectoris, airflow obstruction (FEV(1)% predicted), and C-reactive protein were significant independent predictors of all-cause mortality.
- The final multivariable model demonstrated good predictive accuracy (C statistic 0.78) and calibration.
- The model's performance was consistent in patients meeting GOLD criteria for COPD.
Conclusions:
- Ischemic heart disease, specifically angina, is a strong predictor of mortality in COPD patients.
- Clinical evaluation of COPD patients should include assessment for ischemic heart disease.
- Adequate treatment of angina in COPD patients may improve overall prognosis.
Background:
Cardiovascular diseases are the major cause of mortality in patients with chronic obstructive pulmonary disease (COPD), however, are rarely considered in prediction models in patients with COPD.
Objective:
To quantify the effect of cardiovascular determinants on mortality in patients with a GP's diagnosis of COPD.
Methods:
Four hundred and five patients aged ≥65 years with a diagnosis of COPD (244 with COPD by spirometry) were followed up for an average period of 4.2 (SD 1.4) years. Cox proportional hazard regression analyses with bootstrapping techniques were performed to identify independent predictors of all-cause mortality.
Results:
In multivariable analysis, all-cause mortality was best predicted by age [hazard ratio (HR) 1.05 [95% confidence interval (CI): 1.01-1.10] per year of age], angina pectoris on history taking [HR 2.32 (95% CI: 1.50-3.58)], airflow obstruction [HR 1.02 (95% CI: 1.01-1.03) per percentage decrease in level of forced expiratory volume in one second (FEV(1)) as % predicted] and C-reactive protein [HR 1.04 (95% CI: 1.02-1.05] per milligram per millilitre increase), respectively. The final model had a C statistic of 0.78 (95% CI: 0.72-0.83) after bootstrapping, and the calibration of the model was very good. The model performed similarly in the subgroup of 244 patients with COPD according to the GOLD criteria (post-dilatory FEV(1)/forced vital capacity < 0.70).
Conclusions:
Physicians should consider ischaemic heart disease in the clinical evaluation of any patient with a GP's diagnosis of COPD. Angina pectoris on history taking is a strong predictor of all-cause mortality in these patients and should be treated adequately to improve prognosis.
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