Chronic Obstructive Pulmonary Disease and Major Cardiovascular Events: Hospital Resource Use, Survival and Predictors of Death in a Retrospective Cohort from the Brazilian Private Healthcare System

BACKGROUND: Brazilian data on the course of chronic obstructive pulmonary disease (COPD) after a myocardial infarction or stroke are scarce. OBJECTIVES: To estimate the association of myocardial infarction or stroke with death and hospital resource use in patients with COPD in a Brazilian private healthcare network. METHODS: Retrospective cohort of patients aged 40 years or older with a COPD-specific ICD-10 code (J41 to J44) and a spirometry report, followed from the date both criteria were met. Myocardial infarction or stroke was a time-varying exposure: patients with a history at entry were exposed from entry, and those with a first event during follow-up were exposed from the event. Cox models with the time-varying exposure and negative binomial regression were used. RESULTS: The 1,257 patients were followed for 1,368 person-years; 63 had a history of myocardial infarction or stroke at entry and 41 had a first event during follow-up. Sixty-two died, 3.8 per 100 person-years in unexposed and 15.4 in exposed person-time (adjusted HR 3.81; 95% CI 2.00 to 7.27; p < 0.001), with the highest hazard in the first 90 days after an incident event (HR 4.26). Exposed person-time had more hospital admissions (IRR 2.69; 95% CI 1.85 to 3.92) and intensive care unit admissions (IRR 3.77; 95% CI 2.25 to 6.33). CONCLUSION: In patients with COPD, myocardial infarction or stroke was followed by a near fourfold increase in the hazard of death and a threefold increase in hospital admissions.