Abstract：
OBJECTIVE: 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).
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.
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.
摘要：
目的：这项真实世界的研究-首次在西班牙人群中进行此类研究-旨在探讨慢性阻塞性肺疾病（COPD）患者大队列中急性加重后心血管事件和全因死亡的严重风险。
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.
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.
