Stroke is a leading cause of death and disability in the UK. It has been observed that strokes occur more frequently in people who have chronic obstructive pulmonary disease (COPD) than they do in the general population. In fact, people who have COPD are just as likely to die from a cardiovascular cause, that is, from a stroke or a heart attack, as they are from their lung disease.
Research studies have also shown that having COPD means that you are more likely to go on to have a stroke than someone who doesnt have COPD. While researchers are aware of the links between stroke and lung disease and the fact that the two conditions can coexist in the same patient, this understanding has yet to translate into clinical practice. This means that healthcare professionals who treat people with COPD are often unaware that their patients may be high risk for stroke.
Many people who have COPD experience sudden flare ups, or exacerbations, of their disease during which time their symptoms worsen. The period immediately after an acute exacerbation of COPD (AECOPD) has been identified as a critical time, when the risk for stroke increases sharply, by as much as six- to seven-times. The aim of this study is to identify the factors that contribute to this pronounced increase in stroke risk in the post-AECOPD period. Improved understanding of the risk factors for stroke post AECOPD will help clinicians identify who is at greatest risk and adapt their treatment accordingly.
We will use CPRD¬-HES-ONS linked data to identify risk factors that that are associated with an increased risk of an acute stroke in the 90-day period immediately following a severe AECOPD. We will use a previously validated algorithm to define a cohort of study-eligible subjects, namely individuals in CPRD with COPD who have experienced at least one severe acute exacerbation of COPD (i.e. have been hospitalised for AECOPD). We will use a combination of a priori knowledge and literature searches to identify a list of potential risk factors. We will then conduct a series of univariable and multivariable logistic regression analyses to assess which of these factors are associated with an increased odds of experiencing a stroke in the period immediately following the onset of an AECOPD.
Primary outcome: stroke (fatal and non-fatal).
Jennifer Quint - Chief Investigator - Imperial College London
Ann Morgan - Corresponding Applicant - Imperial College London
Chloe Bloom - Collaborator - Imperial College London
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation