A Prospective Study of Cardiovascular Risk of Patients Admitted for Acute Exacerbation of COPD

Chronic obstructive pulmonary disease (COPD) is a major global health concern, characterized by persistent respiratory symptoms and airflow limitation, and it frequently coexists with cardiovascular disease (CVD), which significantly contributes to morbidity and mortality in this population.

This is a prospective study to assess the burden of existing or hidden cardiovascular (CV) and renal disease in patients with acute exacerbation of COPD (AECOPD) in a Hong Kong public hospital setting. By implementing a COPD discharge care bundle with integrated CV/renal screening, the study aims to quantify undiscovered disease prevalence, evaluate risk factors for future exacerbations, and compare re-admission rates against historical controls, ultimately informing integrated cardiopulmonary management strategies.

The objectives and hypotheses are as follows:

Objectives and Hypotheses Primary Objective To describe the prevalence of undiscovered cardiovascular and renal disease burden among patients hospitalized for AECOPD in a Hong Kong public clinical setting.

• Hypothesis: A significant proportion of AECOPD patients will have previously undiagnosed CV or renal diseases identified through proactive screening, highlighting the need for routine assessments.

Secondary Objectives

• To describe the pattern of AECOPD risk factors among COPD patients.
• To describe the hospital re-admission rate after care optimization. • Hypotheses: Patients with identified CV diseases will exhibit higher-risk profiles (e.g., elevated BMI, severe symptoms, frequent prior exacerbations), and the implementation of the care bundle will reduce re-admission rates compared to historical standard care.

Exploratory Objectives

• To describe the hospital re-admission rate after care optimization according to the cause of hospitalization (e.g., COPD exacerbation vs. CV/renal-related causes).
• To describe the change in COPD treatment before and after care optimization. • Hypotheses: Re-admissions will be lower for CV/renal causes post-optimization, and a notable percentage of patients will require medication adjustments, such as escalation of inhaler or cardio-kidney-metabolic medications.

The COPD discharge care bundle includes:

• COPD treatment optimization (per Global Obstructive Lung Disease [GOLD] 14 recommendations).
• CV and renal disease check-up (NT-proBNP, Hba1c, troponin, eGFR, uACR, blood pressure and ECG).
• Early follow-up at weeks 4-8.
• Inhaler technique review and education. Patients with newly screened/diagnosed CV or renal diseases will be managed per routine clinical practice according to the relevant international guidelines, with referrals to cardiologists as needed.

Inclusion criteria

• Age ≥40 years
• Patients hospitalized due to COPD exacerbation.
• Patients diagnosed with COPD, a confirmed COPD diagnosis with a specific FEV1/FVC ratio (<0.70)
• Able to provide informed consent

Exclusion criteria

• Pregnant subjects
• Inability to give informed consent
• Cancer patient who are on active chemotherapy or on palliative care