Introduction: Risk of severe cardiovascular events (CVE) increases following severe exacerbations of COPD (ECOPD). However, the duration of increased risk and the effect of moderate ECOPD are unclear.

Objective: To quantify risk of a severe CVE or death following a moderate or severe ECOPD.

Methods: Patients with COPD were identified in secondary databases between 2014?2018 in Canada, Germany, the Netherlands (NL) and Spain and followed until experiencing a composite outcome (death or hospitalisation for acute coronary syndrome, heart failure, arrhythmias or cerebral ischaemia) or censoring. Time-dependent Cox models compared the outcome risk incrementally over 12 months following an ECOPD (exposure) vs periods outside an ECOPD (non-exposure).

Results: The proportions of patients with 1+ moderate and 1+ severe ECOPD were respectively 27% and 30% (Canada), 30% and 27% (Germany), 23% and 9% (NL), and 77% and 22% (Spain). Severe CVE or death occurred in 31% (Canada), 39% (Germany), 14% (NL) and 36% (Spain) of patients. In all countries, moderate ECOPD increased the risk of outcome for 1?6 months. Severe ECOPD further augmented risk, which was sustained for >12 months.

Conclusion: Patients experience elevated and sustained risk of a severe cardiopulmonary event or death following either moderate, or severe ECOPD, highlighting the urgency for comprehensive clinical management.