Imperial College London
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ProfessorNicholasPeters

Faculty of Medicine, National Heart & Lung Institute

Professor of Cardiac Electrophysiology
 
 
 
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Contact

 

+44 (0)20 7594 1880n.peters Website

 
 
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Assistant

 

Ms Anastasija Schmidt +44 (0)20 7594 1880

 
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Location

 

NHLI officesSir Michael Uren HubWhite City Campus

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Summary

 

Publications

Citation

BibTex format

@article{Graul:2024:10.1164/rccm.202307-1122OC,
author = {Graul, E and Nordon, C and Rhodes, K and Marshall, J and Menon, S and Kallis, C and Ioannides, A and Whittaker, H and Peters, N and Quint, J},
doi = {10.1164/rccm.202307-1122OC},
journal = {American Journal of Respiratory and Critical Care Medicine},
pages = {960--972},
title = {Temporal risk of nonfatal cardiovascular events after chronic obstructive pulmonary disease exacerbation: a population-based study},
url = {http://dx.doi.org/10.1164/rccm.202307-1122OC},
volume = {209},
year = {2024}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Rationale: Cardiovascular events following COPD exacerbations are recognised. Studies to date have been post-hoc analyses of trials, did not differentiate exacerbation severity, included death in the cardiovascular outcome, or had insufficient power to explore individual outcomes temporally. Objectives: We explore temporal relationships between moderate and severe exacerbations with incident, non-fatal hospitalised cardiovascular events, in a primary care-derived COPD cohort. Methods: We included people with COPD in England from 2014-2020, using Clinical Practice Research Datalink(CPRD) Aurum primary care database. Index date was first COPD exacerbation, or for those without exacerbation, date upon eligibility. We determined composite and individual cardiovascular events (acute coronary syndrome, arrhythmia, heart failure, ischaemic stroke, pulmonary hypertension) from linked hospital data. Adjusted Cox Regression models estimated average and time-stratified hazard ratios(aHR). Measurements and Main Results: Among 213,466 patients, 146,448 (68.6%) had any exacerbation;119,124 (55.8%) moderate exacerbation and 27,324 (12.8%) a severe exacerbation. 40,773 cardiovascular events were recorded. There was an immediate period of cardiovascular relative rate post any exacerbation (1-14 days,aHR=3.19,95%CI 2.71-3.76), followed by progressively declining yet maintained effects, elevated after one year(aHR=1.84,1.78-1.91). HRs were highest 1-14 days following severe exacerbations (aHR=14.5,12.2-17.3) but highest 14-30 days following moderate exacerbations (aHR=1.94,1.63-2.31). Cardiovascular outcomes with greatest two-week effects post severe exacerbation were arrhythmia (aHR=12.7,10.3-15.7) and heart failure (aHR=8.31,6.79-10.2). Conclusions: Cardiovascular events following moderate exacerbations occur slightly later than severe exacerbations; heightened relative rates remain beyond one year irrespective of severity. The period immediately following exacerbation presents a cr
AU  - Graul,E
AU  - Nordon,C
AU  - Rhodes,K
AU  - Marshall,J
AU  - Menon,S
AU  - Kallis,C
AU  - Ioannides,A
AU  - Whittaker,H
AU  - Peters,N
AU  - Quint,J
DO  - 10.1164/rccm.202307-1122OC
EP  - 972
PY  - 2024///
SN  - 1073-449X
SP  - 960
TI  - Temporal risk of nonfatal cardiovascular events after chronic obstructive pulmonary disease exacerbation: a population-based study
T2  - American Journal of Respiratory and Critical Care Medicine
UR  - http://dx.doi.org/10.1164/rccm.202307-1122OC
UR  - https://www.atsjournals.org/doi/10.1164/rccm.202307-1122OC
UR  - http://hdl.handle.net/10044/1/108786
VL  - 209
ER  -
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