Healthcare Resource Consumption of Patients with Cardiovascular Events after Exacerbations of Chronic Obstructive Pulmonary Disease in Italy: Results from the EXACOS-CV Study

OBJECTIVES: Assess the healthcare resource consumption of patients experiencing a severe cardiovascular (CV) event after an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), from the Italian Health Service’s perspective.

METHODS: From the Fondazione Ricerca e Salute’s database (administrative data of ~5 million inhabitants/year), COPD patients aged ≥45 were selected between 01/01/2015 and 12/31/2018. In patients with an AECOPD followed by a first severe CV event within one year, hospitalizations, key in-hospital procedures and dispensations of inhaled corticosteroids (ICS) during the year before and after the CV event, were assessed.

RESULTS: Among 69,620 patients with ≥1 AECOPD, 10,269 (14.8%) experienced ≥1 CV event within one-year post-AECOPD (incidence rate 15.8/100 person-years; 95%CI 15.5-16.1). At least one all-cause hospitalization occurred for 6,265 (61.0%) and 5,192 (50.6%) patients during the year before and after the CV event, respectively. On average about 1 admission per capita occurred and the cumulative length of stay was 22.4 (±21.1) and 25.2 (±24.8) days within one year before and after the CV event, respectively. In particular, 1,595 (15.5%) and 2,185 (21.3%) patients had a CV-related hospitalization before and after CV event, respectively. Among in-hospital procedures, percutaneous transluminal coronary angioplasty was performed to 92/2,609 (1.5%) and 207/5,133 (4.0%) patients and operations on vessels to 103/2,609 (3.9%) and 229/5,133 (4.5%) patients, in the year before and after the CV event, respectively. Before CV event, 64.4% (6,616/10,269) COPD patients received ≥1 ICS, this percentage halved (32.0%) at 1-3 months and reached 51.3% (3,722/10,269) from 3-12 months after CV event. Among ICS-treated patients, ICS-long-acting beta agonist as fixed dose combination was the most frequently supplied (77.1% one year before CV event, 86.4% at 1-3 months and 80.9% at 3-12 months following the CV event).

CONCLUSIONS: Our results emphasize the need to prevent AECOPD, their severe CV consequences and related resource consumptions.