Burden of cardiopulmonary events following diagnosis of COPD; a nationwide linked primary care, secondary care and death registry study
C P Gale, M Hale, M Watt, J Munday, J Lipworth, D M G Halpin, D ShrikrishnaAbstract
Background and Objectives
Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) are among the leading causes of death globally. CVD is the most common comorbidity in patients with COPD, affecting up to 70% of patients. COPD is associated with increased risk of cardiovascular and pulmonary events, yet contemporary nationwide information about the magnitude of this risk is limited. We used a nationwide database of linked primary care, secondary care and death registry records from a representative sample in England to describe the incidence and timing of cardiopulmonary (CP) events in patients with COPD.
Methods
This retrospective cohort study included patients with an incident diagnosis of COPD in the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) linked dataset. Patients aged ≥40 years with a first diagnosis of COPD between 01 Jan 2014 and 31 Dec 2019 were included. The primary outcome was CP events defined as any moderate or severe acute exacerbation of COPD (AECOPD), or hospitalisation for heart failure, myocardial infarction, revascularisation, stroke or arrythmia (including atrial fibrillation and flutter, tachycardia and other arrythmias). Hospitalisation spells for cardiovascular events were counted using either the primary-diagnosis only, or diagnosis in any position.
Results
Of 79,567 patients with COPD, mean age was 68 years, 54.0% were male, 28.0% had a cardiovascular event during baseline, 27.0% were prescribed an antiplatelet and 44.5% prescribed a statin. Median follow up was 3.2 years; 40.2% experienced a CP event within 1 year and 62.2% within 5 years of COPD diagnosis. After 5 years of follow up, cardiovascular hospitalisations affected 10.7% of patients when restricted to primary-diagnosis events and 27.4% when including primary and other diagnoses. Event-specific proportions (shown as primary versus any-listed diagnoses) were: heart failure 4.1% vs 14.3%, arrhythmia 3.1% vs 16.9%, myocardial infarction 2.2% vs 3.0%, and stroke 2.6% vs 7.7%. All-cause mortality was 22.6% and severe AECOPD hospitalisation occurred in 25.7%.
Conclusions
Following diagnosis of COPD, our results suggest that between 1–3 in 10 people with COPD will have experienced a cardiovascular event and 2 in 3 will have experienced a CP event within 5 years, with cardiovascular morbidity emerging early after COPD diagnosis. COPD should be considered a high cardiovascular risk condition, and emphasis placed on both the initiation and optimisation of guideline-directed cardiovascular and COPD therapies to comprehensively address cardiopulmonary risk and reduce overall cardiovascular burden.Figure 1:Cumulative incidence plots