Increased risk of decompensated heart failure, acute coronary syndrome, arrythmias and ischemic stroke following exacerbation of COPD: results from a multi-database cohort study
Bibliographic record
Abstract
Abstract Introduction The risk of acute coronary syndrome (ACS), stroke or death is increased following an exacerbation of chronic obstructive pulmonary disease (COPD). However, little is known about the risk of decompensated heart failure (HF) or acute arrhythmias. Purpose To quantify the risk of decompensated HF, ACS, acute arrhythmias and ischemic stroke following an exacerbation of COPD. Methods Individuals living with COPD were identified in electronic healthcare and claims databases between 2014 and 2018 in Canada (n=142,787), Germany (n=126,795), the Netherlands (NL, n=8,020) and Spain (n=24,393) and followed until a first non-fatal severe CV event of interest (defined as a hospitalisation for ACS, decompensated HF, arrythmias and ischemic stroke), death or censoring. For each non-fatal severe CV event, a multivariable time-dependent Cox model compared the risk of outcome in the 12 months following the onset of a COPD exacerbation (exposed period, split into granular sub-periods of time) with the risk of outcome during periods outside an exacerbation (unexposed period), providing adjusted hazard ratios (HR) and 95% confidence intervals. Results Mean age ranged between 65-68 years old and more than 50% of patients were male, in all countries (Table 1). Cardiovascular risk factors and diseases were common, with 47% to 91% of patients prescribed cardiovascular medications. During follow-up a non-fatal severe CV event occurred in 11% of patients in Canada, 23% in Germany, 8% in NL and 24% in Spain. Decompensated HF was the most frequent event of interest and accounted for 35% to 47% of non-fatal CV events, except in Canada where ACS accounted for 37% of events. In the first 7 days following an exacerbation, the HR ranged between 2.59 (95% CI, 2.32 - 2.89) and 72.34 (64.43 - 81.22) for decompensated HF; 5.59 (5.09 - 6.15) and 24.57 (21.70 - 27.83) for ACS; 9.16 (8.36 - 10.03) and 31.18 (26.84 - 36.21) for arrythmia (mainly driven by atrial fibrillation); and between 2.22 (1.88 - 2.63) and 16.12 (13.39 - 19.41) for ischemic stroke (Table 2). The risks remained elevated for 6 months for decompensated HF and 30 days for ACS in all countries except NL. Conclusion The risk of all severe CV events, including decompensated HF and arrhythmias, was increased following an exacerbation of COPD. Despite heterogeneity of findings across countries, our results indicate that an exacerbation of COPD should be considered as an important risk factor for cardiopulmonary events, emphasizing the need for optimized COPD management across specialties.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".