People with chronic obstructive pulmonary disease (COPD), a condition affecting the lungs, have cough and breathlessness on a day-to-day basis. They commonly experience acute deteriorations, also known as exacerbations in which symptoms worsen and are these are usually triggered by infections. Patients may have more cough and feel more breathless compared to usual, requiring antibiotic and oral steroid treatment. It has been established patients experiencing an exacerbation are more likely to have a future exacerbation event, often with greater frequency. Biological links between exacerbations and future events affecting the heart (cardiovascular (CV) events) are also recognized. By investigating the risk of future CV events, in particular relative to an exacerbation event, we can better understand the pathway between COPD exacerbations and CV events and improve treatment among this subgroup of patients. Among patients with COPD experiencing CV events, we will describe the cost to the health care system.
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition. Many individuals experience acute exacerbations of COPD (AECOPD) alongside declining lung function, decreases in quality-of-life, and co-morbidities, including cardiovascular disease (CVD). COPD is associated with a two-to-three-fold increase in risk of CVD, independently of age, sex, smoking history and other confounders. It has been previously established patients experiencing an AECOPD have greater risk of experiencing future AECOPD.
Although complex pathophysiological links between AECOPD and subsequent CV events are established, the relationship of CVD upon COPD progression appears less defined, particularly short-term, and for moderate exacerbations, alongside a range of well-defined CV outcomes (e.g., heart failure and atrial fibrillation). Although the relative risk between multiple AECOPD and CV event is known, absolute risks are unknown. Among COPD patients having an AECOPD followed by a CV event, the healthcare resource utilisation (HCRU) costs within the 12 months surrounding the event (i.e., before or after) – is unknown and necessary for future cost-effective analyses.
The first aim of this study to fully characterise the association between AECOPD and CV events between 2014 and 2019 in England, among patients with diagnosed COPD. Second, we aim to characterise the association between lung function (through GOLD-grade FEV1 spirometry) and CVD. Finally, we aim to quantify HCRUs among patients with AECOPD who experience a CV event, before and after the event. We will base our inclusion criteria similarly to the EXAcerbations of COPD and their OutcomeS-UK(EXACOS-UK) studies. This is a cohort study using time-to-event analyses and Cox regression. Alongside the average risk calculated from start to end of follow-up, we will calculate subperiod risks (e.g., 90 days), of interest to clinicians.
Investigating the role of CVD with AECOPD is important to better understand patients with COPD at higher risk of CVD, who can be treated more effectively.
1. CV events occurring during follow-up, including death and non-fatal CV event (secondary endpoints) [Acute Coronary Syndrome, Arrythmias, Heart Failure, Ischaemic Stroke, Pulmonary Arterial Hypertension] or all-cause death occurring during follow-up, categorised as composite endpoints or individually
2. Healthcare resource utilization (HCRUs)
Jennifer Quint - Chief Investigator - Imperial College London
Emily Graul - Corresponding Applicant - Imperial College London
Anne Ioannides - Collaborator - Imperial College London
Clementine Nordon - Collaborator - AstraZeneca Ltd - UK Headquarters
Constantinos Kallis - Collaborator - Imperial College London
Hannah Whittaker - Collaborator - Imperial College London
Mahmoud Al Ammouri - Collaborator - Imperial College London
Nicholas S Peters - Collaborator - Imperial College London
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation