Risk of cardiovascular events according to the severity of an exacerbation of chronic obstructive pulmonary disease

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

A case-crossover study was conducted using the French exhaustive hospital discharge database (2013-19). Case-patients had a diagnosis of chronic obstructive pulmonary disease, were hospitalized for a CVE in France in 2018-19 (admission date was index date) with no other CVE in ≤12 months, and had ≥1 hospitalization for exCOPD ≤24 weeks before index CVE. The key exposure was hospitalization for exCOPD (overall and according to levels of care intensity) ≤1-4 weeks vs. 9-24 weeks preceding the CVE. Conditional logistic regression models estimated odds ratios (ORs) for the association between hospitalization for exCOPD and different types of CVE. Among 9840 case-patients, the most frequent CVE was decompensated heart failure (5888 case-patients, 59.8%). The CVE risk was greater ≤4 weeks after a hospitalization for any exCOPD [OR, 3.03; 95% confidence interval (CI), 2.90-3.16] and seven times greater if mechanical ventilation was necessary (OR, 6.99; 95% CI, 6.09-8.03). The risk of non-ST-elevation myocardial infarction (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 CVEs: ST-elevation myocardial infarction (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 (OR, 1.34). Ten percent of CVEs were fatal.

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