Association Between Cardiovascular Comorbidities and Clinical Outcomes in Patients Hospitalized for AECOPD

Abstract

Purpose To explore the association of cardiovascular disease (CVD) count and combinations with prolonged length of stay (LOS) and 1-year acute exacerbation of chronic obstructive pulmonary disease (AECOPD)-related readmission among patients hospitalized for AECOPD. Patients and Methods This single-centre retrospective study included 3684 admissions from 2281 patients with AECOPD between 2015 and 2024, without adjustment for baseline COPD severity. The assessed CVDs were hypertension (HTN), ischemic heart disease (IHD), arrhythmia, heart failure (HF), and peripheral arterial disease (PAD). The primary outcome was prolonged LOS, defined as a hospital stay of ≥14 days. Generalized estimating equation logistic regression models and Cox models with patient-level clustering were used to evaluate prolonged LOS and 1-year AECOPD-related readmission, respectively. Subgroup and sensitivity analyses assessed the robustness of the findings for prolonged LOS. Results At least one CVD was present in 71.7% of admissions. After full adjustment, 2 CVDs (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.18–2.16) and ≥3 CVDs (OR: 1.95; 95% CI: 1.30–2.93) were associated with prolonged LOS (P for trend <0.001). The adjusted hazard ratios for 1-year AECOPD-related readmission were 1.38, 1.42, and 1.68 for 1, 2, and ≥3 CVDs, respectively (P for trend = 0.006). HTN + IHD + PAD showed the strongest association with prolonged LOS (OR: 2.53; 95% CI: 1.25–5.12). HTN + Arrhythmia was associated with both prolonged LOS (OR: 1.83; 95% CI: 1.15–2.92) and readmission (hazard ratio: 1.59; 95% CI: 1.04–2.45). Associations of CVD count with prolonged LOS remained generally consistent in subgroup and sensitivity analyses. Conclusion Increasing CVD count was associated with progressively higher risks of prolonged LOS and 1-year AECOPD-related readmission, with the association with prolonged LOS becoming evident from two coexisting CVDs. Associations with these outcomes varied across CVD combinations, suggesting that both CVD count and combination may help identify patients at increased risk of adverse hospital and post-discharge outcomes.