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A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population
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A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population
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Journal Article
A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population
2019
Overview
Patients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis.
Prospective analysis performed in a specific healthcare area. Data were obtained from several sources within the \"data warehouse of the Galician Healthcare Service\" using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0.
A total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83±10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA
DS
-VASc (4.21 vs 3.46;
=0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707±103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%;
<0.001). Independent predictive factors for all-cause mortality were age, heart failure, diabetes, previous thromboembolic event, dementia, COPD, and oral anticoagulation (OA). There were nonsignificant differences in thromboembolic events (1.7% vs 1.5%;
=0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%;
=0.004). Age, valvular AF, OA, and COPD were independent predictive factors for hemorrhagic events. In COPD patients, age, heart failure, vasculopathy, lack of OA, and lack of beta-blocker use were independent predictive factors for all-cause mortality.
AF patients with COPD have a higher incidence of adverse events with significantly increased rates of all-cause mortality and hemorrhagic events than AF patients without COPD. However, comorbid COPD was not associated with differences in cardiovascular death or stroke rate. OA and beta-blocker treatment presented a risk reduction in mortality while digoxin use exerted a neutral effect.
Publisher
Dove Medical Press Limited,Dove Medical Press Ltd,Dove Press,Dove Medical Press
Subject
/ Adrenergic Antagonists - therapeutic use
/ Adult
/ Age
/ Aged
/ Anti-Arrhythmia Agents - therapeutic use
/ Anticoagulants - therapeutic use
/ Atrial Fibrillation - drug therapy
/ Atrial Fibrillation - epidemiology
/ Atrial Fibrillation - mortality
/ Atrial Fibrillation - physiopathology
/ big data
/ Bronchodilator Agents - therapeutic use
/ Child
/ Chronic obstructive pulmonary disease
/ COPD
/ Diabetes
/ Digoxin
/ Enzymes
/ Female
/ Heart Conduction System - physiopathology
/ Humans
/ Infant
/ Male
/ Patients
/ Pulmonary Disease, Chronic Obstructive - drug therapy
/ Pulmonary Disease, Chronic Obstructive - epidemiology
/ Pulmonary Disease, Chronic Obstructive - mortality
/ Pulmonary Disease, Chronic Obstructive - physiopathology
/ Spain
/ stroke
