METHODS: This longitudinal retrospective cohort study analyzed secondary claims data and included patients aged ≥ 40 years with COPD (International Classification of Diseases-10 codes J41-J44). All exacerbations occurring during follow-up were measured. Time-dependent Cox models were used to estimate hazard ratios (HRs) for the association between time periods following an exacerbation of COPD (vs. time prior to a first exacerbation) and occurrence of a first hospitalization for a severe fatal or non-fatal cardiovascular event.
RESULTS: The analysis included 152,712 patients with COPD with a mean age of 73.8 years and 37.6% of whom were female. During a median follow-up of 37 months, 63,182 (41.4%) patients experienced ≥ 1 exacerbation and 13,314 (8.7%) patients experienced ≥ 1 severe cardiovascular event. Following an exacerbation of COPD, the risk of a severe cardiovascular event was increased in the first 30 days [adjusted HR (aHR) 1.44, 95% confidence interval (CI) 1.33-1.55] and remained elevated for 365 days post-exacerbation (aHR 1.13, 95% CI 1.04-1.23). Specifically, the risks of acute coronary syndrome or arrhythmias remained significantly increased for up to 180 days, and the risk of decompensated heart failure for 1 year.
CONCLUSIONS: Among Japanese patients with COPD, the risk of experiencing a severe cardiovascular event increased following a COPD exacerbation and remained elevated for 365 days, emphasizing the need to prevent exacerbations.
方法:这项纵向回顾性队列研究分析了二级索赔数据,纳入年龄≥40岁的COPD患者(国际疾病分类-10代码J41-J44)。测量随访期间发生的所有恶化。时间依赖性Cox模型用于估计COPD加重后时间段之间关联的风险比(HRs)(与首次恶化之前的时间)和首次住院的严重致死性或非致死性心血管事件的发生。
结果:分析包括152,712名COPD患者,平均年龄为73.8岁,其中37.6%为女性。在37个月的中位随访中,63,182例(41.4%)患者经历了≥1次加重,13,314例(8.7%)患者经历了≥1次严重心血管事件。COPD加重后,严重心血管事件的风险在前30天增加[校正后HR(aHR)1.44,95%置信区间(CI)1.33~1.55],并且在加重后365天保持升高(aHR1.13,95%CI1.04~1.23).具体来说,急性冠状动脉综合征或心律失常的风险在长达180天的时间内仍然显著增加,以及1年失代偿性心力衰竭的风险。
结论:在日本COPD患者中,COPD加重后发生严重心血管事件的风险增加,并持续365天,强调需要防止恶化。