Cardiopulmonary risk in the COPD patient: the EPOCONSUL audit

Abstract

Having cardiovascular disease associated with COPD is important, as it increases the risk of adverse cardiopulmonary events. to evaluate the characteristics of COPD patients with cardiovascular disease (CVD) and the therapeutic measures adopted for COPD at the follow-up visit according to COPD clinical control. A is a cross-sectional study with prospective recruitment. This analysis used data from the EPOCONSUL audit, which evaluated outpatient care provided to COPD patients in respiratory clinics in Spain. 4225 patients from 45 hospitals in Spain were audited. Cardiovascular disease was defined as having a diagnosis of active cardiovascular disease. The clinical control of COPD was defined by the criteria established in the Spanish COPD Guidelines (GesEPOC), measured by the RADAR Score, which assesses the clinical impact and stability of COPD. The COPD risk was defined according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification and GesEPOC criteria based on the degree of dyspnea, history of exacerbations, and degree of airflow obstruction. 1562 (37%) patients had CVD, with the frequency increasing in high-risk COPD according to GesEPOC (42.3%) and in type E GOLD (43.4%). Factors associated with having CVD were age ≥ 55 years as a predictor [2.46 (1.60-3.78), p<0.001], being male [1.88 (1.47-2.39), p<0.001], history of at least one hospitalization for COPD in the previous year [1.82 (1.44-2.30), p<0.001], having sleep apnoea [1.62 (1.20-2.20), p = 0.002], dyspnea (MRC-m) ≥ 2 [1.54 (1.26-1.90), p<0.001] and Charlson index without cardiovascular disease ≥ 3 [1.16 (1.09-1.24), p<0.001]. In patients with CVD, poor control of COPD was more frequent (with CVD: 44.2%; without CVD: 29.1%, p < 0.001). Closer follow-up was more frequent in patients with CVD (follow-up visits < 6 months in CVD: 44.5% vs. without CVD: 38.6%, p < 0.001). Changes in COPD treatment during the visit were more frequent in patients with poor control (in 37.8%) vs. good control (in 20.3%), p < 0.001. Cardiovascular disease was common, present in almost half of high-risk COPD patients. Poor clinical control of COPD was more common in patients with CVD, with triple therapy being the most commonly used pharmacological strategy. No differences were observed in the measures taken during the visit, nor in the request for tests or changes made to COPD treatment based on having active CVD associated with COPD. It is urgent and necessary to promote an integrated approach to improve identification and management of cardiopulmonary risk in COPD patients.