Cardiopulmonary Event Prevalence Before First Recorded COPD Diagnosis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

Purpose: Post-COPD diagnosis, individuals have an increased risk of cardiopulmonary events, but little is known about the risk pre-diagnosis. This study extends previous evidence by investigating the prevalence of cardiopulmonary events before the first recorded COPD diagnosis, including within a standardised 3-year pre-diagnosis window, and compared cardiopulmonary risk with that of matched controls without COPD. Patients and Methods: This retrospective, cohort study included patients with a diagnosis of COPD in the Clinical Practice Research Datalink. The overall cohort included patients aged ≥ 35 years with a COPD diagnosis prior to December 31, 2019, from which an incident COPD cohort was identified with first recorded diagnosis between January 1, 2018-December 31, 2019 (index date). Cardiopulmonary events of interest were quantified within 3 years pre-index among those with ≥ 3 years of pre-index data and during the full look-back period. Matched non-COPD patients served as controls (1:2 ratio). Results: Of 426,854 patients with COPD, 77,428 were incident and matched 1:2 to patients without COPD. Patients in the incident cohort (mean age 67.4 [SD 13.6] years, 52% male, 94% White) had a higher prevalence of pre-diagnosis cardiopulmonary events than controls (76.2% versus 45.6%; odds ratio (OR) 3.8, [95% CI: 3.8– 3.9]). This association was consistent, with greater relative odds observed among those with ≥ 3 years pre-index data (n=70,062): 56.6% had a cardiopulmonary event vs 20.9% (OR 4.9, 95% CI: 4.8– 5.0) within 3 years pre-index, including severe cardiovascular events in 16,679 (23.8%) and respiratory events in 32,293 (46.1%) patients. Most common severe cardiovascular events were atrial fibrillation (58.1%), heart failure (46.1%) and myocardial infarction (15.1%). Before diagnosis, patients with incident COPD also had substantially greater HCRU, including 4.3-fold higher inpatient costs than matched controls. Conclusion: Cardiopulmonary events are frequent before COPD diagnosis, and signal elevated cardiopulmonary risk. Understanding the occurrence of antecedent cardiopulmonary events in COPD may enable earlier diagnosis and treatment. Keywords: atrial fibrillation, cardiac arrest, revascularisation, cardiovascular comorbidity, early detection, exacerbation, heart failure, ischaemic stroke, lower respiratory tract infection, myocardial infarction, tachyarrhythmia