Acute COPD Exacerbation and long-term cardiopulmonary outcomes: Real-world EXACOS-CP evidence study in Israel

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common and debilitating respiratory disease. Acute exacerbations of COPD (AECOPD), characterized by a sudden worsening of symptoms, are associated with cardiovascular (CV) morbidity and mortality. However, their impact on cardiopulmonary outcomes (CP) has not been evaluated in Israel. STUDY OBJECTIVE To determine the association between AECOPD and risk of CP outcomes in newly diagnosed COPD patients and to estimate incidence rates across time intervals and exacerbation severity. STUDY DESIGN AND METHODS This retrospective cohort study analyzed data from Clalit Health Services database. Patients aged ≥40 years who were newly diagnosed with COPD between 2010 and 2019 were included. Those who experienced a first moderate or severe AECOPD were compared to those without prior exacerbations. Matching (1:1) on COPD duration, and inverse probability weighting (IPW) further balanced baseline characteristics between groups. Cox proportional hazards models estimated hazard ratios (HRs) with 95% Confidence Interval (CI). RESULTS The matched cohort comprised 51,480 patients. In the IPW-analysis, AECOPD was associated with an increased risk of composite CP event (HR 1.19; 95% CI: 1.16-1.23), CV events (HR 1.12; 95% CI: 1.08-1.16), respiratory outcomes (HR 1.35; 95% CI: 1.30-1.39), severe AECOPD (HR 1.51; 95% CI: 1.44-1.58), mechanical ventilation (HR 1.58; 95% CI: 1.43-1.75), and acute respiratory failure (HR 1.82; 95% CI: 1.65-2.01). CONCLUSIONS Moderate or severe AECOPD significantly increases the risk of CP complications, especially respiratory events. These findings underscore the need for proactive, multidisciplinary management and close follow-up after an exacerbation.