Predictors of acute cardiovascular events following acute exacerbation period for patients with COPD: a nested case–control study

Abstract

Background It has been noted that there is an increase in the incidence of acute cardiovascular events (CVEs) in patients with chronic obstructive pulmonary disease (COPD) during an acute exacerbation (AE), thereby causing increased inpatient mortality. Thus, we have tried to identify predictors of acute CVEs in patients with AECOPD via a nested case–control study. Methods A total of 496 cases hospitalized for AECOPD were included in this study, and followed-up for up to 6 months after discharge. Acute CVEs in the AE period were defined as a new or worsening acute coronary syndrome (ACS), arrhythmia, or left ventricular disfunction (LVD). Predictors of CVEs were selected from several variables, including baseline characteristics and treatments in the stable period as well as symptoms, laboratory tests, complications and treatments in the AE period. Results Thirty cases (6.05%) had acute CVEs, namely 2 had ACS, 13 had LVD and 19 experienced some form of arrhythmia. Four deaths were observed in the CVE group, with significantly increased death risk compared with the non-CVE group (P = 0.001, OR = 5.81). Moreover, patients who had CVEs were more prone to have re-exacerbation within 3 months. Multivariate analysis showed that previous LVD history (P = 0.004, OR = 5.06), 20% increase in heart rate (HR) (P = 0.003, OR = 10.19), electrolyte disturbance (P = 0.01, OR = 4.24) and diuretics (P = 0.002, OR = 6.37) were independent predictors of CVEs. In addition, usage of theophylline, fluoroquinolone and inhaled beta agonists in the AE period were not statistically associated with acute CVEs. Conclusions Our preliminary study indicates that patients hospitalized for AECOPD with previous LVD history or increased HR need close observation and diuretics should be cautiously used with regular electrolyte monitoring. These findings need to be confirmed in a large cohort.

Analysis of the Effect of Mindfulness Behavior Intervention Combined with Progressive Breathing Training on Pulmonary Function Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease

“…Patients with COPD have severe activity limitations in daily life, especially when performing exercise, due to, for example, restricted airflow, which in turn affects their quality of life [ 18 ]. Currently, exercise and respiratory training have become routine care for patients in the stable phase of COPD, but some studies [ 19 , 20 ] have pointed out that routine care is more about following the treatment plan and observing the condition, while respiratory training alone tends to make patients tired, ineffective, and poorly adhered to. This shows that in addition to effective treatments to control symptoms, COPD patients should be given more behavioral guidance and psychological care during treatment and training to help them develop healthy behaviors.…”

Adipocyte dysfunction promotes lung inflammation and aberrant repair: a potential target of COPD

“…To compare the difference among patients with COPD with different BMI, we re-analyzed the clinical data within a prospective cohort. Detailed description of this cohort has been published in our previous studies ( 26 , 27 ). In brief, we recruited patients hospitalized for AECOPD (acute exacerbation of COPD) in the Department of Pulmonary Medicine of Shanghai Zhongshan Hospital between January 2015 and July 2017, collected their clinical information, and followed up their status about recurrent AE (re-AE) and survival within 1 year after discharge.…”

Risk of Death and Cardiovascular Events Following an Exacerbation of COPD: The EXACOS-CV US Study

“…8 COPD exacerbations have been associated with an increased risk of future exacerbations, all-cause mortality, and acute cardiovascular (CV) events. 7,[9][10][11][12][13][14][15][16][17][18][19][20][21] However, research regarding these associations was conducted mainly in selected clinical trial populations 18 and non-US populations, 9,19 who may receive different care than COPD patients in the general US population. Prior studies generally followed patients for 12 months or less, 19,20 and examined only severe exacerbations that required hospitalization.…”

“…7,[9][10][11][12][13][14][15][16][17][18][19][20][21] However, research regarding these associations was conducted mainly in selected clinical trial populations 18 and non-US populations, 9,19 who may receive different care than COPD patients in the general US population. Prior studies generally followed patients for 12 months or less, 19,20 and examined only severe exacerbations that required hospitalization. 13,20 Study results have varied widely, and the importance of exacerbation history and the duration of COPD remains uncertain.…”