(B-027) Incidence of cardiac events in patients with moderate to severe COPD: a retrospective analysis of US claims data

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition associated with an increased risk of cardiovascular events. Some shared risk factors such as systemic inflammation, oxidative stress, and smoking, contribute to the heightened cardiovascular burden. Importantly, the incidence rate of cardiovascular events, including angina and acute myocardial infarction (AMI), in patients with moderate to severe COPD (MTS-COPD) remains inadequately documented.

Objectives: To evaluate the incidence of angina and acute MI in patients with MTS-COPD compared to matched controls without COPD.

Methods: We conducted a retrospective cohort study using Optum Clinformatics DataMart claims data from March 2013 to December 2023. To identify patients with MTS-COPD, we adapted a published algorithm requiring ≥1 ICD-9/10 code for COPD from a hospitalization or emergency visit, or ≥2 ICD codes for COPD from outpatient visits that were at least 30 days apart. Additionally, ≥1 claim for COPD symptoms and ≥1 commonly used MTS-COPD exacerbation treatment were required. The index date was the date patient met the above criteria.

Patients ≥40 years old with 12-months of continuous enrollment before the index date (baseline) and no history of pulmonary tuberculosis, sarcoidosis, cystic fibrosis, asthma, certain autoimmune diseases, cancer, angina, or AMI in the baseline were included. Patients without a COPD diagnosis and meeting the inclusion and exclusion criteria above were matched 1:1 on age, sex, race, and index year to MTS-COPD patients. The control cohort were censored at any COPD claim during follow-up.

ICD codes for angina and AMI in the primary position during hospitalization were used for the identification of cardiovascular events. Patients were followed from index until the first occurrence of angina, AMI, disenrollment, death or December 31, 2023. Incidence rates per 1,000 person-years and incidence rate ratios (IRR) were calculated along with 95% confidence intervals (CI).

Results: A total of 230,222 patients who met the criteria for MTS-COPD were matched to controls. The incidence rate of angina and AMI in the MTS-COPD cohort was 8.6 (95%CI: 8.4, 8.9) and 16.4 (95%CI: 16.1, 16.7), respectively. In the control group, the incidence rates were 3.1 (95%CI: 2.9, 3.3) for angina and 6.4 (95%CI: 6.2, 6.6) for AMI. Patients with MTS-COPD had almost a threefold increase in the rate of angina (IRR: 2.8; 95%CI: 2.6, 2.9) and AMI (IRR: 2.6; 95%CI: 2.5, 2.7) compared to controls.

Conclusions: Patients with MTS-COPD have a significantly higher rate of angina and acute myocardial infarction compared to matched controls without COPD, highlighting the need for proactive cardiac risk assessment and management in this population.