Mortality of Cardiovascular Events in Patients With COPD and Preceding Hospitalization for Acute Exacerbation

Mai Wang, Emily Pei Ying Lin, Li Ching Huang, Chung Yi Li, Yu Shyr, Chao Han Lai

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Background: Acute exacerbation (AE) of COPD may be accompanied by the deterioration of cardiovascular comorbidities, as evidenced by the increased incidence of acute cardiovascular events. Research Question: The goal of this study was to determine whether preceding AE might be associated with mortality of cardiovascular events. Study Design and Methods: Using a health insurance research database in Taiwan, patients with COPD were identified who experienced first-time acute myocardial infarction (AMI; n = 26,442), ischemic stroke (n = 54,959), and intracranial hemorrhage (ICH; n = 14,893) over a 13-year period. In each cohort, 4,356, 6,655, and 1,727 patients, respectively, had been hospitalized for AE within the previous year prior to the index cardiovascular events, and patients with COPD but without hospitalization for AEs constituted the control subjects. ORs of 90-day mortality and hazard ratios (HRs) of overall mortality during follow-up in relation to hospitalization for an AE and the frequency of hospitalization for AEs (ie, 1 and ≥ 2 hospitalizations for AEs) were estimated with adjustment for potential confounders. Results: Hospitalization for an AE was independently associated with 90-day mortality of AMI (OR, 1.33; 95% CI, 1.24-1.43), ischemic stroke (OR, 1.46; 95% CI, 1.36-1.56), and ICH (OR, 1.19; 95% CI, 1.06-1.32). Hospitalization for an AE was associated with overall mortality of AMI (HR, 1.23; 95% CI, 1.19-1.27), ischemic stroke (HR, 1.29; 95% CI, 1.26-1.33), and ICH (HR, 1.19; 95% CI, 1.13-1.26). In addition, compared with control subjects, patients with more frequent hospitalizations for AEs exhibited significant trends at higher risk of 90-day and overall mortality of AMI, ischemic stroke, and ICH. Finally, these results were consistent with propensity score matching-based estimates. Interpretation: Preceding hospitalization for AEs is associated with 90-day and overall mortality of cardiovascular events in COPD.

Original languageEnglish
Pages (from-to)973-985
Number of pages13
Issue number3
Publication statusPublished - Sept 2020
Externally publishedYes


  • acute exacerbation
  • acute myocardial infarction
  • AMI
  • COPD
  • ICH
  • intracranial hemorrhage
  • ischemic stroke

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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