Severity of hospitalised COPD exacerbations and risk of cardiovascular events: a case-crossover study in France

Introduction Risk of cardiovascular event (CVE) increases following a hospitalised COPD exacerbation (HECOPD). This association has not been explored by severity level of HECOPD Objective Quantify the risk of CVE following a HECOPD overall and by severity level. Methods A case-crossover study was conducted using the French national hospital discharge database. Case-patients were people with: (i) COPD diagnosis; (ii) CVE hospitalisation in 2018-2019 (hospitalisation date=index date, ID); (iii) which occurred within 24 weeks of a HECOPD. HECOPD were categorised into groups of increasing severity: group 1 (general ward); group 2 (general ward + acute respiratory failure); group 3 (intensive care – ICU); group 4 (ICU + mechanical ventilation). Conditional logistic regressions estimated the association – expressed as odds ratios (OR) – between hospitalised CVE and HECOPD in 4 weeks vs. 9-24 weeks pre-ID. Results 9,840 case-patients were identified [mean age=77; 66% male] with a CVE within 24 weeks of a HECOPD; 39% of which in the 4 weeks pre-ID. HECOPD increased CVE risk overall (OR 3.0; 95%CI 2.9-3.2) with positive severity-risk relation: OR 1.9 (95%CI 1.8-2.0); OR 2.9 (95%CI 2.6-3.2); OR 6.1 (95%CI 5.5-6.7), OR 7.0 (95%CI 6.1-8.0) in groups 1 to 4, respectively. Conclusion Risk of CVE substantially increases following HECOPD stressing the need for timely monitoring and optimized COPD treatment.