Safety and Epidemiology, Carelon Research, Wilmington, DE, USA.
Global Medical Affairs, AstraZeneca, Wilmington, DE, USA.
Int J Chron Obstruct Pulmon Dis. 2024 Jan 18;19:225-241. doi: 10.2147/COPD.S438893. eCollection 2024.
This study estimated the magnitude and duration of risk of cardiovascular events and mortality following acute exacerbations of chronic obstructive pulmonary disease (AECOPD), and whether risks varied by number and severity of exacerbation in a commercially insured population in the United States.
This was a retrospective cohort study of newly diagnosed COPD patients ≥40 years old in the Healthcare Integrated Research Database from 2012 to 2019. Patients experiencing exacerbations comprised the "exacerbation cohort". Moderate exacerbations were outpatient visits with contemporaneous antibiotic or glucocorticoid administration; severe exacerbations were emergency department visits or hospitalizations for AECOPD. Follow-up started on the exacerbation date. Distribution of time between diagnosis and first exacerbation was used to assign index dates to the "unexposed" cohort. Cox proportional hazards models estimated risks of a cardiovascular event or death following an exacerbation adjusted for medical and prescription history and stratified by follow-up time, type of cardiovascular event, exacerbation severity, and rank of exacerbation (first, second, or third).
Among 435,925 patients, 170,236 experienced ≥1 exacerbation. Risk of death was increased for 2 years following an exacerbation and was highest during the first 30 days (any exacerbation hazard ratio (HR)=1.79, 95% CI=1.58-2.04; moderate HR=1.22, 95% CI=1.04-1.43; severe HR=5.09, 95% CI=4.30-6.03). Risks of cardiovascular events were increased for 1 year following an AECOPD and highest in the first 30-days (any exacerbation HR=1.34, 95% CI=1.23-1.46; moderate HR=1.23 (95% CI 1.12-1.35); severe HR=1.93 (95% CI=1.67-2.22)). Each subsequent AECOPD was associated with incrementally higher rates of both death and cardiovascular events.
Risk of death and cardiovascular events was greatest in the first 30 days and rose with subsequent exacerbations. Risks were elevated for 1-2 years following moderate and severe exacerbations, highlighting a sustained increased cardiopulmonary risk associated with exacerbations.
本研究旨在评估美国商业保险人群中慢性阻塞性肺疾病急性加重（AECOPD）后心血管事件和死亡的风险程度和持续时间，以及风险是否因加重次数和严重程度而异。
这是一项回顾性队列研究，纳入了 2012 年至 2019 年 Healthcare Integrated Research Database 中年龄≥40 岁的新诊断 COPD 患者。发生加重的患者构成“加重队列”。中度加重是指门诊就诊，同时使用抗生素或糖皮质激素治疗；重度加重是指因 AECOPD 急诊就诊或住院。随访从加重日期开始。使用从诊断到首次加重的时间分布来为“未暴露”队列分配索引日期。Cox 比例风险模型估计了在调整医疗和处方史后，在随访时间、心血管事件类型、加重严重程度和加重等级（首次、第二次或第三次）分层后，发生心血管事件或死亡的风险。
在 435925 名患者中，170236 名患者经历了≥1 次加重。加重后 2 年内死亡风险增加，在最初 30 天内风险最高（任何加重的风险比（HR）=1.79，95%置信区间[CI]：1.58-2.04；中度 HR=1.22，95% CI：1.04-1.43；重度 HR=5.09，95% CI：4.30-6.03）。AECOPD 后 1 年内发生心血管事件的风险增加，在最初 30 天内风险最高（任何加重的 HR=1.34，95% CI：1.23-1.46；中度 HR=1.23（95% CI 1.12-1.35）；重度 HR=1.93（95% CI=1.67-2.22））。每次后续的 AECOPD 均与死亡和心血管事件的发生率逐渐升高相关。
首次 30 天内死亡和心血管事件的风险最高，且随随后的加重而增加。中度和重度加重后 1-2 年内风险升高，突出了与加重相关的持续增加的心肺风险。
