Structured Cardiac Assessment and Treatment Following Exacerbations of COPD (SCATECOPD): A Pilot Randomised...

Area of Science:

• Cardiology
• Pulmonology
• Clinical Trials

Background:

• Heart disease is prevalent but often underdiagnosed and undertreated in patients with Chronic Obstructive Pulmonary Disease (COPD).
• Hospitalized COPD exacerbations (ECOPD) are associated with high mortality, readmission rates, and increased cardiac risk.
• Undiagnosed heart failure (HF) affects up to 20% of hospitalized patients.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of an inpatient structured cardiac assessment (SCA) in diagnosing and initiating guideline-recommended treatment for heart disease in ECOPD patients.
• To capture the prevalence of underdiagnosis and undertreatment of heart disease in this population.
• To identify potential outcome measures for future definitive trials.

Main Methods:

• A pilot randomized controlled trial involving 115 inpatients with ECOPD.
• Patients were randomized to either usual care (UC) or SCA.
• SCA included transthoracic echocardiography, CT coronary artery calcium scoring, 24-hour ECG, blood pressure, and diabetes assessment, with a 12-month follow-up.

Main Results:

• SCA led to significantly higher rates of new cardiac diagnoses (73.7% vs. 19.0%) and new cardiac treatments (56.1% vs. 8.6%) compared to UC.
• More patients in the SCA group were newly diagnosed with heart failure (36.8% vs. 12.1%).
• Optimal treatment at discharge was significantly higher in the SCA group (74% vs. 34%) among those diagnosed with heart disease. Major Adverse Cardiovascular Events (MACE) occurred in 10.5% (SCA) vs. 17.2% (UC) over one year.

Conclusions:

• Structured cardiac assessment during ECOPD significantly enhances the diagnosis and treatment of underlying heart disease.
• Heart failure and coronary artery disease were the most frequent new diagnoses identified.
• Major Adverse Cardiovascular Events (MACE) show promise as a primary outcome for future interventional trials in ECOPD patients.