Increasing cardiovascular disease count was associated with progressively higher risks of prolonged length of stay and 1-year AECOPD-related readmission, with the association with prolonged LOS becoming evident from two coexisting CVDs.
Key Findings
Methods
At least one cardiovascular disease was present in the majority of AECOPD hospitalizations.
The study included 3684 admissions from 2281 patients with AECOPD between 2015 and 2024 at a single centre.
At least one CVD was present in 71.7% of admissions.
The five assessed CVDs were hypertension (HTN), ischemic heart disease (IHD), arrhythmia, heart failure (HF), and peripheral arterial disease (PAD).
The study was retrospective and conducted without adjustment for baseline COPD severity.
Results
Having two or more cardiovascular comorbidities was independently associated with prolonged hospital length of stay (≥14 days) in AECOPD patients.
Prolonged LOS was defined as a hospital stay of ≥14 days.
After full adjustment, 2 CVDs were associated with prolonged LOS (OR: 1.60; 95% CI: 1.18–2.16).
Having ≥3 CVDs was associated with an even higher risk of prolonged LOS (OR: 1.95; 95% CI: 1.30–2.93).
There was a statistically significant trend across CVD count categories (P for trend <0.001).
Generalized estimating equation logistic regression models with patient-level clustering were used.
Results
Greater number of cardiovascular comorbidities was associated with higher risk of 1-year AECOPD-related readmission in a dose-response fashion.
Adjusted hazard ratios for 1-year AECOPD-related readmission were 1.38, 1.42, and 1.68 for 1, 2, and ≥3 CVDs, respectively.
The trend across CVD count categories was statistically significant (P for trend = 0.006).
Cox models with patient-level clustering were used to evaluate 1-year AECOPD-related readmission.
The association with readmission was present even with a single CVD (HR: 1.38).
Results
The combination of HTN, IHD, and PAD showed the strongest association with prolonged length of stay among all cardiovascular disease combinations examined.
HTN + IHD + PAD was associated with prolonged LOS with an OR of 2.53 (95% CI: 1.25–5.12).
This was the strongest association with prolonged LOS observed among all specific CVD combinations assessed.
The analysis of CVD combinations was performed in addition to CVD count analyses to assess differential effects.
Results
The combination of hypertension and arrhythmia was associated with both prolonged length of stay and 1-year AECOPD-related readmission.
HTN + Arrhythmia was associated with prolonged LOS (OR: 1.83; 95% CI: 1.15–2.92).
HTN + Arrhythmia was also associated with 1-year readmission (HR: 1.59; 95% CI: 1.04–2.45).
This was one of the few CVD combinations showing statistically significant associations with both outcomes simultaneously.
Results
The association between CVD count and prolonged length of stay remained generally consistent across subgroup and sensitivity analyses.
Subgroup and sensitivity analyses were conducted to assess the robustness of findings for prolonged LOS.
The associations were described as 'generally consistent' across these additional analyses.
These analyses support the robustness of the primary findings linking higher CVD burden to prolonged hospitalization.
Conclusions
Both the number and specific combination of cardiovascular comorbidities may help identify AECOPD patients at increased risk of adverse hospital and post-discharge outcomes.
Associations with prolonged LOS and readmission varied across specific CVD combinations, not just CVD count.
The authors conclude that 'both CVD count and combination may help identify patients at increased risk of adverse hospital and post-discharge outcomes.'
The study suggests a clinically meaningful threshold at two coexisting CVDs for prolonged LOS risk.
The findings were derived from a single-centre study without adjustment for baseline COPD severity, which the authors note as a study characteristic.
What This Means
This research suggests that among people hospitalized for severe flare-ups of chronic obstructive pulmonary disease (COPD), having more heart and blood vessel conditions at the same time is linked to worse outcomes — specifically, longer hospital stays and a higher chance of being readmitted to the hospital within a year for another COPD flare-up. The study looked at nearly 3,700 hospitalizations from over 2,200 patients and found that more than 70% of these patients had at least one cardiovascular condition such as high blood pressure, coronary artery disease, irregular heart rhythms, heart failure, or peripheral artery disease. The risk of a prolonged stay (14 days or more) increased notably when patients had two or more of these conditions together, and the risk of readmission within a year rose steadily with each additional cardiovascular condition.
The research also found that specific combinations of cardiovascular conditions mattered, not just the total number. The combination of high blood pressure, coronary artery disease, and peripheral artery disease was most strongly linked to prolonged hospitalization. The combination of high blood pressure and arrhythmia was notably linked to both longer stays and higher readmission rates. These findings held up across multiple additional analyses designed to test whether the results were reliable.
This research suggests that routinely assessing both the number and the specific types of heart and blood vessel conditions in COPD patients admitted to hospital could help doctors identify who is at greatest risk for complications. This kind of risk stratification might eventually support more targeted monitoring or care planning for high-risk patients, though the findings come from a single hospital and further studies would be needed to confirm and generalize the results.
Fu Y, Hao J, Zeng Y, Qi W, Chen L, Li J, et al.. (2026). Association Between Cardiovascular Comorbidities and Clinical Outcomes in Patients Hospitalized for AECOPD.. International journal of chronic obstructive pulmonary disease. https://doi.org/10.2147/COPD.S641728