COPD and Sudden Cardiac Death | Journal Scan

Study Questions:

What is the association between chronic obstructive pulmonary disease (COPD) and sudden cardiac death (SCD) in the general population?

Methods:

This was a population-based cohort study among 14,926 subjects aged ≥45 years, with up to 24 years of follow-up. Analyses were performed with a (time-dependent) Cox proportional hazard model adjusted for age, sex, and smoking.

Results:

Of the 13,471 persons included in the analysis, 1,615 had a diagnosis of COPD and there were 551 cases of SCD. COPD was associated with an increased risk of SCD (age- and sex-adjusted hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.06-1.70). The risk particularly increased in the period 2,000 days (5.48 years) after the diagnosis of COPD (age- and sex-adjusted HR, 2.12; 95% CI, 1.60-2.82) and increased further to a more than three-fold higher risk in COPD subjects with frequent exacerbations during this period (age- and sex-adjusted HR, 3.58; 95% CI, 2.35-5.44). Analyses restricted to persons without prevalent myocardial infarction or heart failure yielded similar results.

Conclusions:

The authors concluded that COPD is associated with an increased risk for SCD.

Perspective:

This population-based study in community-dwelling middle-aged and elderly persons reports ~30% increased risk of SCD in subjects with COPD. The risk almost doubled in 5 years after the diagnosis of COPD, a trend which was not observed for other causes of death. Furthermore, the risk increases in COPD patients with frequent exacerbations having a higher degree of baseline systemic inflammation. These data may help to make more accurate risk stratification and lead to targeted preventive actions for patients with COPD, including exploring possible implantable cardioverter-defibrillator placement.

Clinical Topics: Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, SCD/Ventricular Arrhythmias, Acute Heart Failure, Smoking

Keywords: Aged, Cohort Studies, Death, Sudden, Cardiac, Follow-Up Studies, Heart Failure, Inflammation, Morbidity, Mortality, Myocardial Infarction, Primary Prevention, Pulmonary Disease, Chronic Obstructive, Proportional Hazards Models, Risk, Smoking


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