Acute COPD Exacerbation and long-term cardiopulmonary outcomes: Real-world EXACOS-CP evidence study in Israel

Background: Chronic obstructive pulmonary disease (COPD) is a common and debilitating respiratory disease. Acute exacerbations of COPD (AECOPD), characterized by a sudden worsening of symptoms, are associated with cardiovascular (CV) morbidity and mortality. However, their impact on cardiopulmonary outcomes (CP) has not been evaluated in Israel. Study objective: To determine the association between AECOPD and risk of CP outcomes in newly diagnosed COPD patients and to estimate incidence rates across time intervals and exacerbation severity. Study design and methods: This retrospective cohort study analyzed data from Clalit Health Services database. Patients aged ≥40 years who were newly diagnosed with COPD between 2010 and 2019 were included. Those who experienced a first moderate or severe AECOPD were compared to those without prior exacerbations. Matching (1:1) on COPD duration, and inverse probability weighting (IPW) further balanced baseline characteristics between groups. Cox proportional hazards models estimated hazard ratios (HRs) with 95% Confidence Interval (CI). Results: The matched cohort comprised 51,480 patients. In the IPW-analysis, AECOPD was associated with an increased risk of composite CP event (HR 1.19; 95% CI: 1.16–1.23), CV events (HR 1.12; 95% CI: 1.08–1.16), respiratory outcomes (HR 1.35; 95% CI: 1.30–1.39), severe AECOPD (HR 1.51; 95% CI: 1.44–1.58), mechanical ventilation (HR 1.58; 95% CI: 1.43–1.75), and acute respiratory failure (HR 1.82; 95% CI: 1.65–2.01). Conclusions: Moderate or severe AECOPD significantly increases the risk of CP complications, especially respiratory events. These findings underscore the need for proactive, multidisciplinary management and close follow-up after an exacerbation.