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Structured Cardiac Assessment and Treatment Following Exacerbations of COPD (SCATECOPD): A Pilot Randomised
Joseph Kibbler1,2, Eduwin Pakpahan3, Stephen McCarthy4
1Department of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK.
Insights
Structured cardiac assessment significantly improved heart disease diagnosis and treatment in hospitalized COPD exacerbation patients. This approach identified more heart failure cases and led to better management, suggesting its value for future trials.
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.
Abstract:
Background/Objectives: Heart disease is common in COPD, yet it is underdiagnosed and undertreated. Heart failure (HF) is undiagnosed in up to 20% of hospital inpatients. Hospitalised exacerbations of COPD (ECOPD) confer high mortality and readmission rates, with an elevated temporal cardiac risk. We performed a pilot randomised controlled trial examining the feasibility and effect of inpatient structured cardiac assessment (SCA) to diagnose and prompt guideline-recommended treatment of heart disease. Methods: A total of 115 inpatients with ECOPD were randomised 1:1 to receive usual care (UC) or SCA, comprising transthoracic echocardiography, CT coronary artery calcium scoring, 24 h ECG, blood pressure, and diabetes assessment. Follow-up was for 12 months. The prevalence of underdiagnosis and undertreatment of heart disease were captured, and potential outcome measures for future trials assessed. Results: Among patients undergoing SCA, 42/57 (73.7%) received a new cardiac diagnosis and 32/57 (56.1%) received new cardiac treatment, compared with 11/58 (19.0%; p < 0.001) and 5/58 (8.6%; p < 0.001) in the UC group. More patients in the SCA group were newly diagnosed with HF (36.8% vs. 12.1%; p = 0.002). When heart disease was diagnosed, the proportion receiving optimal treatment at discharge was substantially higher in SCA (35/47 (74%) vs. 4/11 (34%); p = 0.029). The occurrence of a major adverse cardiovascular event (MACE) showed promise as an appropriate clinical outcome for a future definitive trial. MACEs occurred in 17.2% in usual care vs. 10.5% in SCA in one year, with a continued separation of survival curves during follow up, although statistical significance was not shown. Conclusions: A structured cardiac assessment during ECOPD substantially improved diagnosis and treatment of heart disease. HF and coronary artery disease were the most common new diagnoses. Future interventional trials in this population should consider MACEs as the primary outcome.
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