背景:立即,慢性阻塞性肺疾病(COPD)加重后发生心力衰竭和心律失常的时间风险已得到证实,特别是在恶化后的第一个月。然而,急性加重后发生心力衰竭(HF)或心房颤动/扑动(AF)的患者的临床情况尚不清楚.因此,我们检查了与因HF或AF住院的患者相关的因素,分别,COPD加重后。
方法:我们进行了两项嵌套的病例对照研究,使用与医院事件统计相关的临床实践研究数据链Aurum中的初级保健电子医疗记录,国家死亡率统计办公室,和社会经济数据(2014-2020年)。患者在COPD加重后30天内因HF或AF住院,与GP实践相匹配的对照(HF2:1;AF3:1)。我们使用条件逻辑回归来探讨与HF和AF住院相关的人口统计学和临床因素。
结果:HF住院的几率(1,569例,3,138个对照)随着年龄的增长而增加,II型糖尿病,肥胖,HF和心律失常史,恶化严重程度(住院),大多数心血管药物,金色气流阻塞,MRC呼吸困难评分,和慢性肾病。最强的关联是严重加重(校正比值比(aOR)=6.25,95CI5.10-7.66),先前的HF(AOR=2.57,95CI1.73-3.83),年龄≥80岁(AOR=2.41,95CI1.88-3.09),和先前的利尿剂处方(aOR=2.81,95CI2.29-3.45)。房颤住院几率(841例,2523个对照)随着年龄的增长而增加,男性,严重加重,心律失常和肺动脉高压病史和大多数心血管药物。最强的关联是严重加重(aOR=5.78,95CI4.45-7.50),年龄≥80岁(AOR=3.15,95CI2.26-4.40),心律失常(aOR=3.55,95CI2.53-4.98),肺动脉高压(aOR=3.05,95CI1.21-7.68),和抗凝剂的处方(aOR=3.81,95CI2.57-5.64),强直剂(aOR=2.29,95CI1.41-3.74)和抗心律失常药物(aOR=2.14,95CI1.10-4.15)。
结论:心肺因素与COPD加重后30天因HF住院相关,而只有心血管相关因素和急性加重严重程度与房颤住院相关。了解因素将有助于预防目标人群。
BACKGROUND: An immediate, temporal risk of heart failure and arrhythmias after a Chronic Obstructive Pulmonary Disease (COPD) exacerbation has been demonstrated, particularly in the first month post-exacerbation. However, the clinical profile of patients who develop heart failure (HF) or atrial fibrillation/flutter (AF) following exacerbation is unclear. Therefore we examined factors associated with people being hospitalized for HF or AF, respectively, following a COPD exacerbation.
METHODS: We conducted two nested
case-control studies, using primary care electronic healthcare records from the Clinical Practice Research Datalink Aurum linked to Hospital Episode Statistics, Office for National Statistics for mortality, and socioeconomic data (2014-2020). Cases had hospitalization for HF or AF within 30 days of a COPD exacerbation, with controls matched by GP practice (HF 2:1;AF 3:1). We used conditional logistic regression to explore demographic and clinical factors associated with HF and AF hospitalization.
RESULTS: Odds of HF hospitalization (1,569 cases, 3,138 controls) increased with age, type II diabetes, obesity, HF and arrhythmia history, exacerbation severity (hospitalization), most cardiovascular medications, GOLD airflow obstruction, MRC dyspnea score, and chronic kidney disease. Strongest associations were for severe exacerbations (adjusted odds ratio (aOR)=6.25, 95%CI 5.10-7.66), prior HF (aOR=2.57, 95%CI 1.73-3.83), age≥80 years (aOR=2.41, 95%CI 1.88-3.09), and prior diuretics prescription (aOR=2.81, 95%CI 2.29-3.45). Odds of AF hospitalization (841 cases, 2,523 controls) increased with age, male sex, severe exacerbation, arrhythmia and pulmonary hypertension history and most cardiovascular medications. Strongest associations were for severe exacerbations (aOR=5.78, 95%CI 4.45-7.50), age≥80 years (aOR=3.15, 95%CI 2.26-4.40), arrhythmia (aOR=3.55, 95%CI 2.53-4.98), pulmonary hypertension (aOR=3.05, 95%CI 1.21-7.68), and prescription of anticoagulants (aOR=3.81, 95%CI 2.57-5.64), positive inotropes (aOR=2.29, 95%CI 1.41-3.74) and anti-arrhythmic drugs (aOR=2.14, 95%CI 1.10-4.15).
CONCLUSIONS: Cardiopulmonary factors were associated with hospitalization for HF in the 30 days following a COPD exacerbation, while only cardiovascular-related factors and exacerbation severity were associated with AF hospitalization. Understanding factors will help target people for prevention.