Mortality Risk and Serious Cardiopulmonary Events in Moderate-to-Severe COPD: Post Hoc Analysis of the IMPACT Trial

Wells, James M.; Criner, Gerard J.; Halpin, David; Han, MeiLan K.; Jain, Renu; Lange, Peter; Lipson, David A.; Martínez, Fernando J.; Midwinter, Dawn; Singh, Dave; Wise, Robert A.

doi:10.15326/jcopdf.2022.0332

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…Posthoc analyses of the IMPACT trial, which included patients with variable cardiovascular risks, revealed that the risk of cardiovascular adverse events is significantly increased during a moderate [hazard ratio: 2.63, 95% confidence interval (95% CI): 2.08-3.32] or severe (hazard ratio: 21.84, 95% CI: 17.71-26.93) ECOPD and that the risk remains higher than baseline for 90 days [23]. This analysis also demonstrated that the risk of death was elevated during a severe ECOPD (hazard ratio, 41.22, 95% CI: 26.49-64.15; P < 0.001) [24]. Similar results were found in an observational study in Denmark of patients with COPD and stable CVD (Fig.…”

Section: Prevalence and Incidencementioning

confidence: 54%

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Maeda,

Dransfield

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewChronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are both significant burdens on the healthcare system and often coexist. Mechanistic links between the two conditions and their clinical impact are increasingly understood.Recent findingsRecent studies demonstrate multiple mechanisms by which the pathobiology of COPD may have negative effects on the cardiovascular system. These include extrapulmonary consequences of the COPD inflammatory state, cardiac autonomic dysfunction, which has been recently implicated in worsening respiratory symptoms and exacerbation risk, and mechanical effects of lung hyperinflation on left ventricular diastolic function.Clinical studies have consistently shown a high prevalence of CVD in COPD patients and worsened outcomes (andvice versa). Exacerbations of COPD have also been demonstrated to dramatically increase the risk of cardiovascular events. While some safety concerns exist, medications for COPD and cardiovascular disease should be used in accordance with respective guidelines. However, real-world data show suboptimal management for patients with COPD and CVD.SummaryCOPD and cardiovascular disease have complicated interrelationships. Further mechanistic studies may lead to defining better targets for interventions. Education for medical professionals and implementation of novel screening protocols should be encouraged to fill in the gaps in clinical care for these patients.

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Section: Prevalence and Incidencementioning

confidence: 54%

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Maeda,

Dransfield

2023

Current Opinion in Pulmonary Medicine

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“…However, the risk increase was found to be more prolonged than previously suggested,14 15 28 as it remained elevated for up to 6 months. The shorter duration of elevated risk identified in the post-hoc analyses of the IMPACT trial28 31 may be explained by the close monitoring of patients included in trials, potentially minimising the risk of adverse events, differences in the study populations (eg, underlying cardiac comorbidity) and trial duration. From a pathophysiological perspective, persistent post-exacerbation inflammation may contribute to elevated systemic inflammation and non-recovery of symptoms following the acute phase of the exacerbation 32.…”

Section: Discussionmentioning

confidence: 99%

Elucidating the risk of cardiopulmonary consequences of an exacerbation of COPD: results of the EXACOS-CV study in Germany

Vogelmeier,

Rhodes,

Garbe

et al. 2024

BMJ Open Resp Res

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BackgroundExacerbations of chronic obstructive pulmonary disease (COPD) represent a period of vulnerability. This study explored the association between time periods following an exacerbation and the risk of severe cardiovascular (CV) events or death in Germany.MethodsA longitudinal cohort study was conducted using routinely collected healthcare data. Individuals with COPD were identified between 2014 and 2018. Exposure was moderate or severe exacerbation of COPD. Periods at risk were the 1–7, 8–14, 15–30, 31–180 and 181–365 days following each exacerbation onset occurring after cohort entry. The main outcome of interest was the first hospitalisation for a CV event or all-cause death. Time-dependent Cox proportional hazards models estimated the HR for the association between subperiods versus periods outside exacerbations, and the risk of outcome.ResultsAmong 126 795 patients, 58 720 (46.3%) exacerbated at least once and 48 982 (38.6%) experienced at least one CV event or died during a median follow-up of 36 months. The rate of outcome was increased during 1–7 days following a severe exacerbation onset (HR 15.84, 95% CI 15.26 to 16.45), and remained elevated for up to a year (181–365 days HR 1.17, 95% CI 1.11 to 1.23). In the 1–7 days following a moderate exacerbation onset, the increased rate was HR 1.17, 95% CI 1.05 to 1.31).ConclusionThe risk of a CV event or death increased in time periods following both moderate and severe exacerbations of COPD, emphasising the need to promptly manage the risk of CV events following the onset of an exacerbation, to prevent exacerbations of any severity, and more generally, to address the cardiopulmonary risk in patients with COPD.

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“…1). Aufbauend auf die Ergebnisse der IMPACT-und der ETHOS-Studie, die bei ähnlichen Patientenpopulationen die Effekte der Behandlung mit unterschiedlichen LABAund LAMA-und ICS-Präparaten evaluierten, kann auch die Behandlung mit Triple-Therapien bei symptomatischen Patienten, die unter Therapie Exazerbationen entwickeln, einen signifikanten Überlebensvorteil im Vergleich zu LABA und LAMA bedingen [22,23].…”

Section: Therapie Und Auswirkung Auf Die Mortalitätunclassified

COPD – was hat sich in GOLD 2023 geändert und ist für den Praxisalltag relevant?

Klemmer

Alter

Vogelmeier

2023

Dtsch Med Wochenschr

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Was ist neu? Diagnostik und Einschätzung des Schweregrads: Eine Diagnosestellung erfordert den spirometrischen Nachweis einer nachweisbaren obstruktiven Ventilationsstörung. GOLD empfiehlt weiterhin das FEV1/FVC-Verhältnis von <0,7 als Kriterium. In der deutschsprachigen COPD-Leitlinie sowie der NVL COPD ist die Möglichkeit aufgeführt, eine COPD zu diagnostizieren, wenn keine Obstruktion nachweisbar ist. Zur Einschätzung des Schweregrades hat GOLD das ABCD-Schema zum ABE-Schema verändert und fasst damit die Gruppen C und D zur Gruppe E (E=Exazerbationen) zusammen, um deren klinische Relevanz unabhängig von der sonstigen klinischen Symptomatik des Patienten zu betonen. Pharmakologische Therapie: Die Initialtherapie erfolgt nach dem ABE-Scheme. GOLD legt besonderen Wert auf die Auswahl des richtigen Inhalationssystems. Für die Follow-up-Situation ist entscheidend, ob die Patienten nur unter Symptomen leiden oder zwischenzeitlich unter Therapie auch Exazerbationen aufgetreten sind. Therapie und Auswirkung auf die Mortalität: Eine Reihe von nicht medikamentösen Therapiemaßnahmen hat signifikante Auswirkungen auf die Mortalität: diese reichen von Rauchentwöhnung über Rehabilitation, Langzeitsauerstofftherapie und nicht invasive Beatmung bis zur Lungenvolumenreduktion. Die Behandlung mit Triple-Therapien kann bei Patienten, die unter Therapie Exazerbationen entwickeln, einen signifikanten Überlebensvorteil im Vergleich zu LABA und LAMA bedingen. Exazerbationen GOLD schlägt eine neue Definition von COPD vor, die Symptome, Zeitverlauf, klinische Zeichen und Ursachen beinhaltet. Noch bedeutsamer ist aber die empfohlene Einteilung des Schweregrades, der jetzt auch darauf abhebt, dass wichtige Differenzialdiagnosen (insbesondere Herzinsuffizienz, Pneumonie, Lungenembolie) ausgeschlossen werden.

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Mortality Risk and Serious Cardiopulmonary Events in Moderate-to-Severe COPD: Post Hoc Analysis of the IMPACT Trial

Abstract: For personal use only. Permission required for all other uses.

Cited by 8 publications

References 27 publications

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice

Elucidating the risk of cardiopulmonary consequences of an exacerbation of COPD: results of the EXACOS-CV study in Germany

COPD – was hat sich in GOLD 2023 geändert und ist für den Praxisalltag relevant?

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