A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population

Abstract

Background

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.

Methods

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.

Results

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 CHA₂DS₂-VASc (4.21 vs 3.46; P=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%; P<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%; P=0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%; P=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.

Conclusion

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.

Keywords:

• atrial fibrillation
• big data
• CHA₂DS₂-VASc
• COPD
• stroke

Supplementary material

Selection, identification, and calculation of CHA₂DS₂-VASc score, mortality (SIAC-AP, SIAC-CID)

CIAP2 – Classification of Primary Care: cutoff date: 31/12/2013

• Selection of patients with an episode and/or an active conditioning factor with the CIAP2 code K78 – Atrial fibrillation/atrial flutter (SIAC-AP).

• Identification of patients with an episode and/or an active conditioning factor with code K83 – Valvular heart disease (SIAC-AP).

• Calculation of CHA₂DS₂-VASc score, as defined by the European Society of Cardiology.¹ This scale awards 1 point for each of the following risk factors: heart failure, arterial hypertension, age 65–74 years, vascular disease (myocardial infarction, peripheral arterial disease, or aortic plates), female gender, and diabetes mellitus, and 2 points for a previous stroke and age ≥75 years.

• History of acute congestive failure with one of the following codes: K74 – Ischemic heart disease with angina; K75 – Acute myocardial infarction; K76 – Ischemic heart disease without angina; K77 – Heart failure (SIAC-AP) (HF).

• Arterial hypertension: K85 – Elevated blood pressure; K86 – Hypertension uncomplicated; K87 – Hypertension complicated (damage in target organs); K85 – (SIAC-AP).

• Age ≥75 years and gender (SIAC-CID).

• Diabetes mellitus: T89 – Insulin-dependent diabetes mellitus; T90 – non insulin-dependent diabetes mellitus (SIAC-AP).

• Ictus or acute transient ischemia symptoms: K89 – Transient cerebral ischemia; K90 – Stroke/cerebrovascular accident; K91 – cerebrovascular disease; K92 – Atherosclerosis/peripheral artery disease; K93 – Pulmonary embolism (SIAC-AP).

Anticoagulation/antiaggregation therapy (SIAC-PF): cutoff date 31/12/2013

Patients with an active prescription of oral anticoagulants and antiaggregants on 31/12/2013 (SIAC-PF).

• The following drugs are identified with an Anatomical, Therapeutic, Chemical classification system code: acetyl-salicylic acid and/or clopidogrel, acenocumarol, warfarin (with the calculation of defined daily dose), apixaban, dabigatran, and rivaroxaban.

Reference

• JohnsonLSJuhlinTEngströmGNilssonPMReduced forced expiratory volume is associated with increased incidence of atrial fibrillation: the Malmo preventive projectEuropace201416218218823960091
   PubMed Web of Science ®Google Scholar

Disclosure

The authors report no conflicts of interest in this work.