The sustained increase of cardiovascular risk following COPD exacerbations: meta-analyses of the EXACOS-CV studies
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
Background The EXAcerbations of COPD and their OutcomeS on CardioVascular disease (EXACOS-CV) multi-database studies have consistently shown an increased risk of serious cardiovascular event following COPD exacerbations, but with some risk temporality variations. EXACOS-CV results were meta-analysed to increase their generalisability and improve precision. Methods Studies conducted in Canada, the United States, Germany, the Netherlands, Spain, Italy, Japan and England were meta-analysed, amounting to 1 030 875 individuals. Generally, each study included individuals aged ≥40 years with a COPD diagnosis in 2014–2019; primary outcome was the composite of non-fatal acute coronary syndrome, decompensated heart failure, ischaemic stroke, arrhythmias and all-cause death. Pooled hazard ratios (HR p ) of risks in post-exacerbation periods ( versus periods outside exacerbations) were obtained through random effects meta-analysis. Results Time periods following an exacerbation (any severity) were associated with increased and sustained risks of the composite outcome: HR p 10.22 (95% CI 5.34–19.57) in days 1–7 and HR p 1.24 (95% CI 1.09–1.40) in days 181–365. Risks were elevated for 6 months (HR p 1.25, 95% CI 1.01–1.55 in days 31–180) and 1 year (HR p 1.48, 95% CI 1.11–1.96 in days 181–365) following a moderate or a severe exacerbation, respectively. In newly diagnosed individuals, risks were increased until days 31–180: HR p 1.66 (95% CI 1.14–2.42) and HR p 1.61 (95% CI 1.28–2.02) following the first and the second post-diagnosis exacerbation, respectively. Conclusion Risk of severe cardiovascular events is sustainably increased following an exacerbation of COPD, even early and moderate ones. Cardiopulmonary risk reduction should be a global core target of COPD management.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it