The Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) was used to enroll adults aged ≥40 years with poorly controlled asthma and a history of ≥1 hospitalization for asthma exacerbation. A total of 4607 patients from Florida, Nebraska, and New York, who were hospitalized and experienced their first subsequent episode of acute MI or ischemic stroke, were identified.
A composite of acute MI and ischemic stroke comprised the primary outcome of interest. A regression analysis was used to compare incidence rates of the primary outcome during days 1 to 7, 8 to 14, and 15 to 28 after asthma exacerbation with a reference period, or the period before and after the 3 risk periods.
The incidence of acute MI or ischemic stroke was 25.0/100 person-years during the reference period. This incidence rate increased during days 1 to 7 (129.1/100 person-years; adjusted incidence rate ratio [aIRR], 5.04; 95% CI, 4.29-5.88; P <.001). During days 8 to 15 and 15 to 28, there was a decline in the steadily high incidence rate (50.1/100 person-years [aIRR, 1.96; 95% CI, 1.51-2.48; P <.001] and 38.0/100 person-years [aIRR, 1.48; 95% CI, 1.20-1.81; P <.001], respectively).
When evaluated separately, there was an increased incidence rate of acute MI during the first risk period vs the reference period (aIRR, 5.75; 95% CI, 4.75-6.90; P <.001) as well as during days 8 to 14 (aIRR, 1.98; 95% CI, 1.43-2.66; P <.001) and days 15 to 28 (aIRR, 1.38; 95% CI, 1.05-1.78; P =.02) after the asthma exacerbation. In addition, the incidence rate of ischemic stroke increased during the first risk period (aIRR, 3.82; 95% CI, 2.80-5.07; P <.001), second risk period (aIRR, 1.91; 95% CI, 1.23-2.81; P =.002), and third risk period (aIRR, 1.67; 95% CI, 1.19-2.25; P =.002).
The lack of a random sample, the inclusion of patients from only 3 US states, and the reliance on administrative data represent potential limitations of the study.
However, these findings may “provide the opportunities for applying cardiovascular prevention measures to patients with severe asthma exacerbation during hospitalization and transition to outpatient care,” the researchers wrote.
Disclosures: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Raita Y, Camargo CA, Faridi MK, Brown DFM, Shimada YJ, Hasegawa K. Risk of acute myocardial infarction and ischemic stroke in patients with asthma exacerbation: A population-based, self-controlled case series study [published online July 16, 2019]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2019.06.043