Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
Survival After First Myocardial Infarction in Patients With and Without Chronic Obstructive Pulmonary Disease
An estimated three million people are affected by chronic obstructive pulmonary disease
(COPD) in the UK, giving it a prevalence of 1.5% of the population in 2007/08. COPD accounts
for approximately 30,000 deaths each year in the UK and is an important co-morbidity in
those dying from other smoking related diseases, most commonly ischaemic heart disease and
lung cancer. The National COPD audit showed a very high level of co-morbidity, the
association with cardiovascular disease being particularly strong with 51% of patients with
cardiovascular disease having been admitted for COPD within the preceding 24 months.
Patients with COPD are at increased risk of myocardial infarction compared to the general
population. Although this increase in cardiovascular risk exists, it is not clear is whether
survival after myocardial infarction is different in patients with and without COPD and what
factors contribute to this survival difference. Differences in survival may arise due to
differences in prescribing certain drugs such as beta-blockers, differences in prevalence of
risk factors (e.g. current smoking status) or increased COPD events such as exacerbations
which themselves are associated with increased mortality.
The investigators primary aim is to investigate whether survival after first myocardial
infarction is shorter in patients with COPD than those without COPD and to establish reasons
for these differences in survival.
This study is part of the CALIBER (Cardiovascular disease research using linked bespoke
studies and electronic records) programme funded over 5 years from the NIHR and Wellcome
Trust. The central theme of the CALIBER research is linkage of the Myocardial Ischaemia
National Audit Project (MINAP) with primary care (GPRD) and other resources. The overarching
aim of CALIBER is to better understand the aetiology and prognosis of specific coronary
phenotypes across a range of causal domains, particularly where electronic records provide a
contribution beyond traditional studies. CALIBER has received both Ethics approval (ref
09/H0810/16) and ECC approval (ref ECC 2-06(b)/2009 CALIBER dataset).
Objectives:
1. To investigate survival differences after first myocardial infarction in patients with
and without COPD.
2. To investigate if these survival differences exist due to a) differences in prevalence
of risk factors (e.g. smoking) b) differences in management after myocardial infarction
(e.g. uptake of cardiac rehabilitation, prescription of beta-blockers) and c) COPD
related events (e.g. exacerbations).
;
Observational Model: Cohort, Time Perspective: Retrospective
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