Accelerated FEV₁decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients

Abstract

Accelerated lung function decline has been associated with increased risk of cardiovascular disease (CVD) in a general population, but little is known about this association in chronic obstructive pulmonary disease (COPD). We investigated the association between accelerated lung function decline and CVD outcomes and mortality in a primary care COPD population.COPD patients without a history of CVD were identified in the Clinical Practice Research Datalink (CPRD-GOLD) primary care dataset (n=36 282). Accelerated FEV1 decline was defined using the fastest quartile of the COPD population's decline. Cox regression assessed the association between baseline accelerated FEV1 decline and a composite CVD outcome over follow-up (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, coronary artery disease, and CVD mortality). The model was adjusted for age, gender, smoking status, BMI, history of asthma, hypertension, diabetes, statin use, mMRC dyspnoea, exacerbation frequency, and baseline FEV1 percent predicted.6110 (16.8%) COPD patients had a CVD event during follow-up; median length of follow-up was 3.6 years [IQR 1.7–6.1]). Median rate of FEV1 decline was –19.4 mL·year−1 (IQR, –40.5 to 1.9); 9095 (25%) patients had accelerated FEV1 decline (>–40.5 mL·year−1), 27 287 (75%) did not (≤ –40.5 mL·year−1). Risk of CVD and mortality was similar between patients with and without accelerated FEV1 decline (HRadj 0.98 [95%CI, 0.90–1.06]). Corresponding risk estimates were 0.99 (95%CI 0.83–1.20) for heart failure, 0.89 (95%CI 0.70–1.12) for myocardial infarction, 1.01 (95%CI 0.82–1.23) for stroke, 0.97 (95%CI 0.81–1.15) for atrial fibrillation, 1.02 (95%CI 0.87–1.19) for coronary artery disease, and 0.94 (95%CI 0.71–1.25) for CVD mortality. Rather, risk of CVD was associated with mMRC score ≥2 and ≥2 exacerbations in the year prior.CVD outcomes and mortality were associated with exacerbation frequency and severity and increased mMRC dyspnoea but not with accelerated FEV1 decline.

Challenges and Pitfalls of Using Repeat Spirometry Recordings in Routine Primary Care Data to Measure FEV1 Decline in a COPD Population

“…Previous studies have investigated how patient characteristics are associated with FEV 1 decline; however, the purpose of this study was to primarily show how mean rates of FEV 1 decline differed depending on the definition used. [8][9][10]20,21 We found that in the cohorts that did not exclude measurements or individuals due to increases in FEV 1 , the mean rates of FEV 1 and within patient variation remained similar. For this reason, the definition used to create population one (i.e., using all available FEV 1 measurements over follow-up) could be used to describe the rate of FEV 1 decline in a COPD population using CPRD data.…”

“…Whilst an FEV 1 measurement of 7 L would be considered high in COPD patients, a distribution of FEV 1 measurements was considered based off previous studies. [8][9][10] A previous validation study of spirometry in CPRD GOLD found that of 96.5% of spirometry traces recorded at the general practice in COPD patients were of adequate quality where a respiratory clinician was able to make an interpretation. 6 Of these, 27.9% were identified as post-bronchodilator FEV 1 , 7.2% were confirmed to be pre-bronchodilator FEV 1 , and for the remaining measurements it was unclear if the measurements were pre-or post-bronchodilator.…”

Differences in severe exacerbations rates and healthcare utilisation in COPD populations in the UK and France

“…While this algorithm would improve the certainty of including patients with COPD, rather than patients with asthma, for example, it does limit the comparability of findings with patients identified in the EGB data. Despite this, our previous work shows that only 7.3% of patients with a clinical diagnosis of COPD were never smokers in a CPRD GOLD COPD cohort in the UK and we believe that patients hospitalised for COPD or on long-term COPD therapy would have also been given a COPD diagnosis in primary care in France 22…”

Impact of COPD or Asthma on the Risk of Atrial Fibrillation: A Systematic Review and Meta-Analysis

“…A total of 5 included studies focused on the relationship between asthma and AF risk ( 16 , 20 – 22 ). Li et al ( 13 ) reported the race- and sex-specific association of asthma with AF incidence, separately.…”