Santos Salud, Manito Nicolás, Sánchez-Covisa Joaquín, Hernández Ignacio, Corregidor Carmen, Escudero Luciano, Rhodes Kirsty, Nordon Clementine
Servicio de Neumología, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2025 Jan;78(2):138-150. doi: 10.1016/j.rec.2024.06.003. Epub 2024 Jun 25.
This real-world study-the first of its kind in a Spanish population-aimed to explore severe risk for cardiovascular events and all-cause death following exacerbations in a large cohort of patients with chronic obstructive pulmonary disease (COPD).
We included individuals with a COPD diagnosis code between 2014 and 2018 from the BIG-PAC health care claims database. The primary outcome was a composite of a first severe cardiovascular event (acute coronary syndrome, heart failure decompensation, cerebral ischemia, arrhythmia) or all-cause death following inclusion in the cohort. Time-dependent Cox proportional hazards models estimated HRs for associations between exposed time periods (1-7, 8-14, 15-30, 31-180, 181-365, and >365 days) following an exacerbation of any severity, and following moderate or severe exacerbations separately (vs unexposed time before a first exacerbation following cohort inclusion).
During a median follow-up of 3.03 years, 18 901 of 24 393 patients (77.5%) experienced ≥ 1 moderate/severe exacerbation, and 8741 (35.8%) experienced the primary outcome. The risk of a severe cardiovascular event increased following moderate/severe COPD exacerbation onset vs the unexposed period, with rates being most increased during the first 1 to 7 days following exacerbation onset (HR, 10.10; 95%CI, 9.29-10.97) and remaining increased >365 days after exacerbation onset (HR, 1.65; 95%CI, 1.49-1.82).
The risk of severe cardiovascular events or death increased following moderate/severe exacerbation onset, illustrating the need for proactive multidisciplinary care of patients with COPD to prevent exacerbations and address other cardiovascular risk factors.
这项现实世界研究是西班牙人群中的首例此类研究，旨在探讨一大群慢性阻塞性肺疾病（COPD）患者病情加重后发生心血管事件和全因死亡的严重风险。
我们纳入了2014年至2018年期间来自BIG-PAC医疗保健索赔数据库且有COPD诊断代码的个体。主要结局是首次发生严重心血管事件（急性冠状动脉综合征、心力衰竭失代偿、脑缺血、心律失常）或纳入队列后全因死亡的复合情况。时间依赖性Cox比例风险模型估计了在任何严重程度的病情加重后暴露时间段（1 - 7天、8 - 14天、15 - 30天、31 - 180天、181 - 365天和>365天）与首次病情加重后中度或重度病情加重分别（与队列纳入后首次病情加重前的未暴露时间段相比）之间关联的风险比（HR）。
在中位随访3.03年期间，24393例患者中有18901例（77.5%）经历了≥1次中度/重度病情加重，8741例（35.8%）出现了主要结局。与未暴露时间段相比，中度/重度COPD病情加重发作后严重心血管事件的风险增加，在病情加重发作后的前1至7天发生率增加最为明显（HR = 10.10；95%置信区间[CI]，9.29 - 10.97），在病情加重发作>365天后仍保持增加（HR = 1.65；95%CI，1.49 - 1.82）。
中度/重度病情加重发作后严重心血管事件或死亡的风险增加，这表明需要对COPD患者进行积极的多学科护理，以预防病情加重并处理其他心血管危险因素。
