What is the clinical evidence from this study?

Study design: Cohort. Population: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (n=3906). Intervention: Comorbid coronary artery disease (CAD) vs. No CAD. Primary outcome: Length of hospital stay (days) (p=<0.001).

February 12, 2022Open Access

Clinical and economic burden of comorbid coronary artery disease in patients with acute exacerbation of chronic obstructive pulmonary disease: sex differences in a nationwide cohort study

Q: What are the key findings of this study?

Comorbid coronary artery disease in men hospitalized for acute exacerbation of COPD was associated with a longer length of hospital stay and higher total cost compared to those without CAD.

YCYanan CuiHebei Agricultural University ZZZijie ZhanCentral South University YMYiming MaKansas City VA Medical Center

Key Result

Comorbid coronary artery disease in men hospitalized for acute exacerbation of COPD was associated with a longer length of hospital stay and higher total cost compared to those without CAD.

Study Design

Type

Cohort (n=3,906)

Multicenter

Yes

Structured PICO

Does comorbid CAD worsen clinical outcomes and economic burden in hospitalized AECOPD patients?

Population

3,906 patients admitted with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) as their primary diagnosis, from the ACURE study (nationwide observational real-world study in China).

Intervention

Presence of comorbid coronary artery disease (CAD)

Comparator

Absence of comorbid coronary artery disease (CAD)

Outcome

Length of hospital stay and economic burden (total cost) during hospitalization

Comorbid CAD is associated with longer hospital stays and higher costs in men hospitalized for AECOPD, highlighting the need for sex-specific attention to cardiovascular comorbidities in COPD management.

Main Result

Absolute Event Rate: 10% vs 9%

p-value: p=<0.001

Limitations

Data on treatments for CAD before and during hospitalization were unavailable
Patients might be admitted to the hospital at different periods of their exacerbations with no accurate data regarding when symptoms started
Missing data (e.g., blood gas) in a portion of patients
Not all patients had follow-up data within 30 days after discharge
No long-term prognostic analysis was performed because the study is still ongoing with only 30-day data available

Abstract

BACKGROUND: Coronary artery disease (CAD) is a common comorbidity of chronic obstructive pulmonary disease (COPD). However, data related to the impact of CAD on outcomes of acute exacerbation of COPD (AECOPD) are limited and whether the relationship depends on sex remains unknown. Our aim was to determine the impact of comorbid CAD on clinical outcomes among men and women with AECOPD. METHODS: We used data from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study, which is a nationwide observational real-world study conducted between September 2017 and February 2020 at 163 centers in patients admitted with AECOPD as their primary diagnosis. Patients were stratified according to the presence or absence of CAD in men and women. The primary outcomes were the length of hospital stay and economic burden during hospitalization. RESULTS: Among 3906 patients included in our study, the prevalence of CAD was 17. 0%, and it was higher in women than in men (19. 5% vs. 16. 3%; P = 0. 034). Age and other cardiovascular diseases were common factors associated with comorbid CAD in men and women, while body-mass index, cerebrovascular disease, and diabetes were determinants in men and pre-admission use of long-acting beta-adrenoceptor agonist and home oxygen therapy were protective factors in women. Only in men, patients with CAD had a longer length of hospital stay (median 10. 0 vs. 9. 0 days, P < 0. 001), higher total cost during hospitalization (median 1502. 2 vs. 1373. 4, P < 0. 001), and more severe COPD symptoms at day 30 compared to those without CAD. No significant difference was found in women. Comorbid CAD showed no relationship with 30-day readmission or death regardless of sex. In our real-world study, mortality/readmission risk within 30 days increased in patients with previous frequent hospitalizations and poorer pulmonary function. CONCLUSIONS: In hospitalized AECOPD patients, comorbid CAD was significantly associated with poorer short-term outcomes in men. Clinicians should have heightened attention for men with comorbid CAD to achieve an optimal management of AECOPD patients.

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