METHODS: 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).
RESULTS: 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).
CONCLUSIONS: 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.
方法:我们从BIG-PAC医疗保健声明数据库中纳入了2014年至2018年间患有COPD诊断代码的个体。主要结果是第一个严重心血管事件的复合(急性冠脉综合征,心力衰竭代偿失调,脑缺血,心律失常)或纳入队列后的全因死亡。时间相关的Cox比例风险模型估计了任何严重程度加重后暴露时间段(1-7、8-14、15-30、31-180、181-365天和>365天)之间的关联的HR。以及分别在中度或重度加重后(与纳入队列后首次加重前的未暴露时间相比)。
结果:在3.03年的中位随访中,24393例患者中的18901例(77.5%)经历了≥1次中度/重度加重,和8741(35.8%)经历了主要结局。与未暴露期相比,中度/重度COPD加重发作后发生严重心血管事件的风险增加,在加重发作后的前1至7天内,发病率增加最多(HR,10.10;95CI,9.29-10.97),并且在加重发作后>365天保持增加(HR,1.65;95CI,1.49-1.82)。
结论:中度/重度加重发作后,严重心血管事件或死亡的风险增加,说明需要积极的多学科护理COPD患者,以预防加重和解决其他心血管危险因素.