EXAcerbations of COPD and their OutcomeS on CardioVascular diseases (EXACOS-CV) Programme: protocol of multicountry observational cohort studies

• Published in: BMJ open 2023-04, Vol.13 (4), p.e070022-e070022
• Main Authors: Nordon, Clementine, Rhodes, Kirsty, Quint, Jennifer K, Vogelmeier, Claus F, Simons, Sami O, Hawkins, Nathaniel M, Marshall, Jonathan, Ouwens, Mario, Garbe, Edeltraut, Müllerová, Hana
• Format: Article
• Language: English
• Subjects: Ambulatory care; CARDIOLOGY; Cardiovascular Diseases - epidemiology; Chronic airways disease; Chronic illnesses; Chronic obstructive pulmonary disease; Cohort analysis; Cohort Studies; Disease Progression; Emergency medical care; EPIDEMIOLOGY; Health care policy; Health insurance; Heart attacks; Hospitalization; Hospitals; Humans; Ischemia; Longitudinal Studies; Observational studies; Observational Studies as Topic; Patients; Pharmacy; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - epidemiology; Respiratory Medicine; Retrospective Studies; VASCULAR MEDICINE
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-070022

IntroductionIn patients with chronic obstructive pulmonary disease (COPD), the risk of certain cardiovascular (CV) events is increased by threefold to fivefold in the year following acute exacerbation of COPD (AECOPD), compared with a non-exacerbation period. While the effect of severe AECOPD is well established, the relationship of moderate exacerbation or prior exacerbation to elevated risk of CV events is less clear. We will conduct cohort studies in multiple countries to further characterise the association between AECOPD and CV events.Methods and analysisRetrospective longitudinal cohort studies will be conducted within routinely collected electronic healthcare records or claims databases. The study cohorts will include patients meeting inclusion criteria for COPD between 1 January 2014 and 31 December 2018. Moderate exacerbation is defined as an outpatient visit and/or medication dispensation/prescription for exacerbation; severe exacerbation is defined as hospitalisation for COPD. The primary outcomes of interest are the time to (1) first hospitalisation for a CV event (including acute coronary syndrome, heart failure, arrhythmias or cerebral ischaemia) since cohort entry or (2) death. Time-dependent Cox proportional hazards models will compare the hazard of a CV event between exposed periods following exacerbation (split into these periods: 1–7, 8–14, 15–30, 31–180 and 181–365 days) and the unexposed reference time period, adjusted on time-fixed and time-varying confounders.Ethics and disseminationStudies have been approved in Canada, Japan, the Netherlands, Spain and the UK, where an institutional review board is mandated. For each study, the results will be published in peer-reviewed journals.