Chronic obstructive pulmonary disease is a common illness affecting the lungs and making breathing difficult. When chronic obstructive pulmonary disease suddenly worsens, it is called a "lung attack." People living with this lung condition often have other health issues, more commonly than the general population, especially heart problems. To provide better care, doctors need ways to predict when lung or heart attacks are more likely. However, existing ways of using routine data to predict when someone is going to have a heart attack that are used for the general population may not be as effective for people living with Chronic obstructive pulmonary disease. This study aims to use de-identified information from primary and secondary care to develop and test tools to predict when lung attacks are more likely to happen and to validate and modify existing heart attack risk assessment tools for people with chronic obstructive pulmonary disease. Achieving this will benefit people living with chronic obstructive pulmonary disease, as it can help determine high-risk periods, allowing for preventive measures and better patient care.
People with chronic obstructive pulmonary disease (COPD) often experience exacerbations and face a higher risk of cardiovascular diseases (CVD) than the general population. COPD exacerbations and CVD contribute to most excess mortality in COPD. As exacerbations can cause a significant decline in overall health, predicting who is at high risk can significantly improve and optimize risk mitigation strategies, including preventive pharmacotherapy.
To the best of our knowledge, no validated exacerbation risk scoring tool exists for the UK COPD population, and current tools rely on positive exacerbation history and cannot predict the first exacerbation, limiting their usefulness upon COPD diagnosis. Further, COPD is now recognized as an independent risk factor for CVD. Therefore, risk scoring tools such as the QRISK which are recommended for the general population are at risk of underestimating CVD risk in COPD patients and thus result in suboptimal preventive strategies. As such, before using CVD and exacerbation risk scoring tools, it is essential to validate and, if necessary, update them. Through this project, we will validate ACCEPT and QRISK3 using the CPRD Aurum database (January-2004 to December-2022) by evaluating their calibration, discrimination, and clinical utility by drawing the calibration plot, calculating area-under-the-curve, and conducting decision curve analysis. We will evaluate the performance of ACCEPT 2.0 in predicting the time to the first COPD exacerbation and, if required, will re-estimate coefficients of ACCEPT 2.0 to predict such an outcome. We will also evaluate fairness and equity metrics, including calibration in subgroups of sex, socio-economic status, and ethnicity. If ACCEPT and QRISK3 are not calibrated, we will follow best practice standards in updating such tools to generate improved predictions. This research will benefit COPD patients by determining high-risk periods for exacerbations and heart conditions, enabling preventive measures and better management.
Acute Exacerbations of chronic obstructive pulmonary disease (COPD)
Coronary heart disease
Ischaemic stroke
Transient ischaemic attack
Mohsen Sadatsafavi - Chief Investigator - University Of British Columbia
Joseph Emil Amegadzie - Corresponding Applicant - University Of British Columbia
Amin Adibi - Collaborator - University Of British Columbia
Jennifer Quint - Collaborator - Imperial College London
John Hurst - Collaborator - University College London ( UCL )
Mona Bafadhel - Collaborator - King's College London (KCL)
Richard Russell - Collaborator - King's College London (KCL)
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation