Cardiac Autonomic Function Predicts Incident COPD Hospitalizations in the Atherosclerosis Risk in Communities Study

MacDonald, David M; Ji, Yan; Adabag, Selçuk; Alonso, Antonio Eduardo; Chen, L.Y.; Henkle, Benjamin; Juraschek, Stephen P; Norby, Faye L.; Lutsey, Pamela L.; Kunisaki, K.M.

doi:10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a5029

Cited by 2 publications

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“…A secondary analysis of the BLOCK COPD trial, which tested metoprolol (another cardioselective beta-blocker) in COPD patients, showed an association between decreased HRV and increased ECOPD risk but only in groups that did not receive metoprolol [8]. Data from a large multicenter prospective cohort study of Atherosclerosis Risk in Communities (ARIC) showed that decreased HRV and orthostatic hypotension were associated with COPD-related hospitalization over 26.9 years of follow up [9 ▪ ].…”

Section: Mechanistic Relationshipsmentioning

confidence: 99%

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Maeda,

Dransfield

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewChronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are both significant burdens on the healthcare system and often coexist. Mechanistic links between the two conditions and their clinical impact are increasingly understood.Recent findingsRecent studies demonstrate multiple mechanisms by which the pathobiology of COPD may have negative effects on the cardiovascular system. These include extrapulmonary consequences of the COPD inflammatory state, cardiac autonomic dysfunction, which has been recently implicated in worsening respiratory symptoms and exacerbation risk, and mechanical effects of lung hyperinflation on left ventricular diastolic function.Clinical studies have consistently shown a high prevalence of CVD in COPD patients and worsened outcomes (andvice versa). Exacerbations of COPD have also been demonstrated to dramatically increase the risk of cardiovascular events. While some safety concerns exist, medications for COPD and cardiovascular disease should be used in accordance with respective guidelines. However, real-world data show suboptimal management for patients with COPD and CVD.SummaryCOPD and cardiovascular disease have complicated interrelationships. Further mechanistic studies may lead to defining better targets for interventions. Education for medical professionals and implementation of novel screening protocols should be encouraged to fill in the gaps in clinical care for these patients.

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Section: Mechanistic Relationshipsmentioning

confidence: 99%

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Maeda,

Dransfield

2023

Current Opinion in Pulmonary Medicine

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“…Incident HF attributed to exacerbations is thought to come from the increase in pulmonary arterial pressures, low blood oxygen levels (12) and activation of adrenoceptors of the autonomic nervous system. (12,13) However, shared symptomology of HF and COPD exacerbations makes new HF diagnosis difficult, with HF often missed (3,12,14) or occurring in tandem; approximately 8% of people primarily diagnosed with HF also have a secondary diagnosis of exacerbation (15). Studies have investigated COPD progression in HF (12) and conversely, HF progression across COPD phenotypes, (12,16) but few have focused on exacerbating COPD alone (15) and no studies have examined factors associated with hospitalization with a HF diagnosis following a COPD exacerbation.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with non-fatal heart failure and atrial fibrillation or flutter within the first 30 days post COPD exacerbation: a nested case-control study

Graul,

Nordon,

Rhodes

et al. 2024

Preprint

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Background An immediate, temporal risk of heart failure and arrhythmias after a Chronic Obstructive Pulmonary Disease (COPD) exacerbation has been demonstrated, particularly in the first month post-exacerbation. However, the clinical profile of patients who develop heart failure (HF) or atrial fibrillation/flutter (AF) following exacerbation is unclear. Therefore we examined factors associated with people being hospitalized for HF or AF, respectively, following a COPD exacerbation. Methods We conducted two nested case-control studies, using primary care electronic healthcare records from the Clinical Practice Research Datalink Aurum linked to Hospital Episode Statistics, Office for National Statistics for mortality, and socioeconomic data (2014-2020). Cases had hospitalization for HF or AF within 30 days of a COPD exacerbation, with controls matched by GP practice (HF 2:1;AF 3:1). We used conditional logistic regression to explore demographic and clinical factors associated with HF and AF. Results Odds of HF (1,569 cases, 3,138 controls) increased with age, type II diabetes, obesity, HF and arrhythmia history, exacerbation severity (hospitalization), most cardiovascular medications, GOLD airflow obstruction, MRC dyspnea score, and chronic kidney disease. Strongest associations were for severe exacerbations (adjusted odds ratio (aOR)=6.25, 95%CI 5.10-7.66), prior HF (aOR=2.57, 95%CI 1.73-3.83), age≥80 years (aOR=2.41, 95%CI 1.88-3.09), and prior diuretics prescription (aOR=2.81, 95%CI 2.29-3.45). Odds of AF (841 cases, 2,523 controls) increased with age, male sex, severe exacerbation, arrhythmia and pulmonary hypertension history and most cardiovascular medications. Strongest associations were for severe exacerbations (aOR=5.78, 95%CI 4.45-7.50), age≥80 years (aOR=3.15, 95%CI 2.26-4.40), arrhythmia (aOR=3.55, 95%CI 2.53-4.98), pulmonary hypertension (aOR=3.05, 95%CI 1.21-7.68), and prescription of anticoagulants (aOR=3.81, 95%CI 2.57-5.64), positive inotropes (aOR=2.29, 95%CI 1.41-3.74) and anti-arrhythmic drugs (aOR=2.14, 95%CI 1.10-4.15). Conclusions Cardiopulmonary factors were associated with hospitalization for HF in the 30 days following a COPD exacerbation, while only cardiovascular-related factors and exacerbation severity were associated with AF hospitalization. Understanding factors will help target people for prevention.

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Cardiac Autonomic Function Predicts Incident COPD Hospitalizations in the Atherosclerosis Risk in Communities Study

Cited by 2 publications

References 0 publications

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Factors associated with non-fatal heart failure and atrial fibrillation or flutter within the first 30 days post COPD exacerbation: a nested case-control study

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