Predischarge screening for chronic obstructive pulmonary disease in patients with acute coronary syndrome and smoking history
Introduction
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity, mortality and resource use worldwide, involving until the 20% of the general population [1], [2]. COPD and ischemic heart disease (IHD) share cigarette smoking as common risk factor [1], [2], [3]. COPD prevalence ranges from 5% to 20% of IHD patients and exerts a synergistic negative effect on prognosis [1], [2], [3], [4], [5]. Several studies suggested that COPD is largely underdiagnosed in IHD patients and therefore it is not appropriately treated, contributing to further affect clinical outcome [6], [7]. Spirometry is the gold standard for COPD diagnosis. However, it cannot be applied systematically. This is particularly true early after acute coronary syndrome (ACS), mainly for safety, but also for cost concerns [1]. Thus, a simple, reliable and reproducible algorithm to screen patients at higher probability of undiagnosed COPD is desirable, especially for ACS patients. Peak expiratory flow rate (PEFR) and Respiratory Health Screening Questionnaire (RHSQ) are simple and reproducible tools that can be used as first approach to assess COPD [1].
We have hypothesized that a combination of PEFR measurement and RHSQ result could be a reliable screening for COPD in patients hospitalized for ACS and with smoking history. Hence, to test this hypothesis, we have designed and conducted the Screening for COPD in ACS Patients (SCAP) trial.
Section snippets
Study design
The SCAP study is a single-center, single-group, investigator-driven, prospective trial involving consecutive ACS patients with smoking history referred to our University Hospital between December 2014 and August 2015 (Fig. 1). The research protocol was approved by the corresponding Ethics Authority (Comitato Etico Unico della Provincia di Ferrara). All patients gave their written informed consent. The study was registered at www.clinicaltrials.gov with identifier NCT02324660.
Study population
Inclusion criteria
Results
Overall, we included 137 patients (Fig. 1, Table 1). Baseline, laboratory and angiographic characteristics of the study population are reported in Table 1. Median hospital stay was 4 days [3–6 days]. One-hundred thirty-three (97%) patients received percutaneous coronary intervention (PCI). Due to not significant or small vessel disease, 4 (3%) patients were medically managed. Of note, the 87% (n = 119) of our study population patients received beta-blockers at hospital discharge (metoprolol or
Discussion
At the best of our knowledge, this is the first study describing a prespecified, prospective screening tool to discriminate ACS patients at negligible risk of undiagnosed COPD. We found that undiagnosed COPD is relatively common in patients with smoking history admitted to hospital for ACS (29% of patients, 95%CI 21%–36%). We demonstrated that a simple screening applied by cardiologists might be sufficient to identify those patients with a low risk of concomitant undiagnosed COPD (42% of
Conclusions
In conclusion, our study shows that undiagnosed COPD is relatively common in ACS patients with smoking history and that the application of a simple screening including PEFR and RHSQ can be safely performed before hospital discharge. This screening allows the identification of patients with negligible risk of undiagnosed COPD.
Conflict of interest
The authors report no relationships that could be construed as a conflict of interest
Financial disclosures
No authors reported financial disclosures.
Funding/support
The study was an investigator driven clinical trial conducted by the University of Ferrara.
Acknowledgements
GC is the guarantor of the content of the manuscript, including the data and analysis.
GC, RP, SB, MC, CB: conception, design, analysis and interpretation of data.
SM, EM, FZ, LF, ET, FG: data analysis and interpretation, drafting of the manuscript and revising it critically for important intellectual content.
RF and AP: final approval of the manuscript submitted.
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