A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population
Authors Rodríguez-Mañero M, López-Pardo E, Cordero A, Ruano-Ravina A, Novo-Platas J, Pereira-Vázquez M, Martínez-Gómez Á, García-Seara J, Martínez-Sande JL, Peña-Gil C, Mazón P, García-Acuña JM, Valdéz-Cuadrado L, González-Juanatey JR
Received 17 May 2018
Accepted for publication 5 November 2018
Published 12 February 2019 Volume 2019:14 Pages 371—380
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Moisés Rodríguez-Mañero,1–3,* Estrella López-Pardo,4,* Alberto Cordero,3,5 Alberto Ruano-Ravina,4 José Novo-Platas,4 María Pereira-Vázquez,1 Álvaro Martínez-Gómez,1 Javier García-Seara,1–3 Jose-Luis Martínez-Sande,1–3 Carlos Peña-Gil,1–3 Pilar Mazón,1–3 Jose María García-Acuña,1–3 Luis Valdés-Cuadrado,4,6 José Ramón González-Juanatey1–3
1Servicio de Cardiología, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain; 2IDIS (Instituto para el Desarrollo e Integración de la Salud), Madrid, Spain; 3CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Madrid, Spain; 4Xerencia de Xestión Integrada, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain; 5Hospital Universitario San Juan de Alicante, Sant Joan d’Alacant, Spain; 6Servicio de Neumología, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
*These authors contributed equally to this work
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
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