PURPOSE: Risk factors for and cardiovascular disease (CVD) are common in subjects with Chronic Obstructive Pulmonary Disease (COPD) and predicts morbidity and all-cause mortality in COPD patients. Here we determine how patients are investigated for exacerbation of CVD in subjects admitted with AECOPD.
METHODS: Retrospective data review of subjects admitted to two tertiary care facilities during a 12 month period with AECOPD. GOLD criteria were used to verify underlying COPD and Anthonisen criteria to classify AECOPD.
RESULTS: We studied 163 admissions (82 patients), age 65±11years, mean GOLD stage 3.4±0.8, mean FEV1 30.3±1.1%. Risk factors for CVD (excluding smoking) were present in 37% of subjects and documented underlying CVD in 49%. On admission, 85% of subjects received an ECG, of which 56.4% had abnormalities and 39.3% had new abnormalities. Subjects with ECG abnormalities had lower FEV1 (33.5±1.5 vs 27.7±1.4, p< 0.004). Within 24hrs of admission, 47.1% of subjects had troponins, of which 9.3% were >0.05ng/mL, but only 19.6% had repeat troponins. Of those with new ECG abnormalities, 37.5% did not receive troponins within 24hrs. Subjects with new ECG abnormalities have more CV risk factors (p< 0.044), and are more likely to receive troponins (p< 0.032). New ECG changes and age predict CV work-up. There was a trend for subjects with an abnormal ECG to have longer LOS (9.9±0.9 vs 13.2±1.5 days, p=NS) but subjects with a history of IHD or ECG suggestive of ischemia, had significantly longer LOS (10.2±0.8 vs 16.2±2.5 days, p< 0.01).
CONCLUSION: Underlying cardiovascular disease is prevalent in subjects admitted to hospital with AECOPD and exacerbation of CVD is poorly studied as an etiology for dyspnea despite evidence that CVD causes significant morbidity and mortality in this population. A larger prospective study is necessary to determine the impact of full cardiac work-up on morbidity and mortality of AECOPD.
CLINICAL IMPLICATIONS: Multiple CV risk factors, new ECG changes and signs of new/old ischemia on the ECG should prompt cardiovascular work-up in subject admitted for AECOPD to optimize management of CVD in this patient population.
DISCLOSURE: Cheryl Lane, Grant monies (from sources other than industry) Work supported by the BC Lung Association, Heart and Stroke Foundation of Canada and the Pacific Lung Health Centre COPD program.; No Product/Research Disclosure Information