11 / 24
cardiovascular disease or multiple risk fac-
tors for cardiovascular disease and whose
forced expiratory volume in 1 s (FEV1) was
50–70% of predicted and whose FEV1/
forced vital capacity (total volume of exha-
lation) was ≤70%.
A Cox model was used with a time-
dependent covariate for acute exacerbation
of COPD events (defined as symptomatic
deterioration requiring treatment with
antibiotics or systemic corticosteroids).
The team controlled for other risk factors
and analyzed the hazard of cardiovascular
disease events at 1–30 days, 31 days–1 year,
and >1 year following acute exacerbation
of COPD events.
The primary analysis included data from
all four SUMMIT arms (placebo, fluticasone
furoate, vilanterol, fluticasone furoate +
vilanterol), but additional sensitivity analy-
ses restricted the model to individual study
arms.
The hazard of cardiovascular disease
events following acute exacerbations of
COPD was increased significantly, par-
ticularly during the first 30 days following
an acute exacerbation of COPD (hazard
ratio 3.8; 95% confidence interval 2.7, 5.5),
though it remained increased between 30
days to 1 year (hazard ratio 1.8; 95% confi-
dence interval 1.5, 2.3); and was no longer
significant beyond 1 year following an acute
exacerbation of COPD (hazard ratio 1.1; 95%
confidence interval 0.8, 1.6).
When analyses were restricted to the
individual treatment arms in SUMMIT, the
same general pattern was observed in
each, with an increased risk for cardiovas-
cular disease events early after an acute
exacerbation of COPD and no significant
increase >1 year after the acute exacerba-
tion of COPD.
Their findings led Dr Kunisaki and his team
to consider evaluating interventions follow-
ing an exacerbation of COPD in patients
with cardiovascular disease.
Dr Kunisaki said, “One approach might be
to study currently used cardiac medica-
tions, such as antiplatelet agents, statins
and/or beta-blockers immediately following
exacerbations of COPD. Another might be
to use experimental drugs that specifically
reduce inflammation.”
“Until effective interventions are identified,”
he added, “patients who have experienced
a recent COPD exacerbation should pay
attention to and seek immediate care for
symptoms of myocardial infarction.”
He added, “Providers should be particu-
larly aware of the risk of a cardiovascular
disease event in patients seeking acute
medical care following an exacerbation of
COPD.”
Study limitations included the fact that all
participants had a history of cardiovascular
disease or multiple risk factors for cardio-
vascular disease.
Whether exacerbations of COPD pose
the same risk of cardiovascular disease in
patients with no or lower cardiovascular
disease risk is not known.
Another study of COPD reported at ATS
assessed the incidence of in-hospital
COPD mortality from 2005–2014. The
number of hospitalizations for COPD in
the US fluctuated within a narrow range
between 2005 and 2014. In-hospital
deaths decreased substantially during that
same time.
Khushboo Goel, MD, of the University of
Arizona, Tucson, and colleagues, set out
to examine trends in COPD hospitaliza-
tions and in-hospital mortality in a nationally
representative sample and to evaluate
potential differences by sex and race.
She and her team analyzed data from the
Healthcare Cost and Utilization Project
Nationwide Inpatient Sample, which cap-
tures 95% of all hospital discharges in the
US.
They reported 8,575,820 hospitaliza-
tions for COPD-related health problems
between 2005–2014. During that time,
those who died in the hospital declined
from 24,226 to 9090, a 62% decrease.
Dr Goel said, “This was certainly an encour-
aging trend. We expected to see a decline
because of improvements in caring for con-
ditions such as pneumonia, sepsis, septic
shock, and thromboembolic diseases asso-
ciated with COPD exacerbations, but the
magnitude of the decline in mortality was
surprising.”
She noted that the decreasing mortality
trend applied to white, black, and Hispanic
patients.
Most striking was that each year, women
accounted for most of the hospitalizations
and in-hospital deaths. Women made up
57–58% of hospitalizations and 51–55% of
in-hospital deaths.
Dr Goel said, “Possible explanations for
the higher COPD burden in US women
include the growing number of women who
smoke, the increased severity of symp-
toms they may experience, and longer life
expectancy.”
The study also found that from 2005 to
2014, the average age of those hospital-
ized remained nearly constant at 67 years.
The number of COPD patients treated at
teaching hospitals increased from 212,346
to 371,215 and the average length of a hos-
pital stay decreased from 5.2 to 4.2 days.
PracticeUpdate Editorial Team
Providers should be particularly aware of
the risk of a cardiovascular disease event
in patients seeking acute medical care
following an exacerbation of COPD.
ATS 2017
11
VOL. 2 • NO. 1 • 2017