Detrimental Impact of Chronic Obstructive Pulmonary Disease in Atrial Fibrillation: New Insights from Umbria Atrial Fibrillation Registry

Abstract

Background and objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Among extra-pulmonary manifestations of COPD, atrial fibrillation (AF) is commonly observed in clinical practice. The coexistence of COPD and AF significantly affects the risk of cardiovascular morbidity and mortality. Nonetheless, the mechanisms explaining the increased risk of vascular events and death associated to the presence of COPD in AF are complex and not completely understood. We analyzed data from an Italian network database to identify markers and mediators of increased vascular risk among subjects with AF and COPD. Materials and Methods: Cross-sectional analysis of the Umbria Atrial Fibrillation (Umbria-FA) Registry, a multicenter, observational, prospective on-going registry of patients with non-valvular AF. Of the 2205 patients actually recruited, 2159 had complete clinical data and were included in the analysis. Results: the proportion of patients with COPD was 15.6%. COPD patients had a larger proportion of permanent AF when compared to the control group (49.1% vs. 34.6%, p < 0.0001) and were more likely to be obese and current smokers. Other cardiovascular risk factors including chronic kidney disease (CKD), peripheral artery disease and subclinical atherosclerosis were more prevalent in COPD patients (all p < 0.0001). COPD was also significantly associated with higher prevalence of previous vascular events and a history of anemia (all p < 0.0001). The thromboembolic and bleeding risk, as reflected by the CHA2DS2VASc and HAS-BLED scores, were higher in patients with COPD. Patients with COPD were also more likely to have left ventricular (LV) hypertrophy at standard ECG than individuals forming the cohort without COPD (p = 0.018). Conclusions: AF patients with COPD have a higher risk of vascular complications than AF patients without this lung disease. Our analysis identified markers and mediators of increased risk that can be easily measured in clinical practice, including LV hypertrophy, CKD, anemia, and atherosclerosis of large arteries.

Impact of Chronic Obstructive Pulmonary Disease on Atrial Fibrillation Ablation Outcomes According to the National Readmission Database

“… 32 – 34 Similarly, COPD patients are more likely to have peripheral vascular diseases and atherosclerosis. 35 The present study did not find a difference in outcomes of in-hospital occurrence of acute myocardial infarction and ischemic stroke/TIA between the 2 groups segregated based on COPD status. However, our study evaluated these outcomes if they happened during the index admission.…”

Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients

“…A total of 5316 results were retrieved from the search (939 from PubMed and 4377 from EMBASE). After duplicates removal, and title and abstract screening, 130 full-texts were assessed for eligibility, and 46 studies were included for quantitative synthesis (Table 1 and Supplementary material online, Figure S1), with a total of 4 232 784 AF patients included: 3 studies were secondary analyses of randomized trials, 28,38,62 19 cohorts were based on administrative databases, 19,20,26,27,31,32,35,36,39,41,49,50,53,55,56,60,61,63,64 16 were observational multicentre studies, 21,22,24,25,33,34,37,40,42,[45][46][47][48]52,54,57 and 8 were observational single-centre studies 23,29,30,43,44,51,58,…”

“…We examined the association of the main thromboembolic risk factors with COPD in AF patients (Table 4), in all studies for which we retrieved data broken down by COPD status. Overall, 17 studies were included for female sex, 21,23,25,28,30,33,34,39,43,[46][47][48]52,54,56,57,61 14 studies for CHF, 21,23,25,28,30,33,34,43,[45][46][47]52,54,56 hypertension, diabetes mellitus, and CAD, 21,23,25,28,30,33,34,43,[46][47][48]52,54,56 13 studies for history of stroke/transient ischaemic attack (TIA), 21,23,25,…”

“…Overall, 17 studies were included for female sex, 21,23,25,28,30,33,34,39,43,[46][47][48]52,54,56,57,61 14 studies for CHF, 21,23,25,28,30,33,34,43,[45][46][47]52,54,56 hypertension, diabetes mellitus, and CAD, 21,23,25,28,30,33,34,43,[46][47][48]52,54,56 13 studies for history of stroke/transient ischaemic attack (TIA), 21,23,25,28,30,33,34,…”

“…21,23,30,33,34,39,43,46,47,52,54,56 Furthermore, 7 studies reported mean (SD) data on CHA 2 DS 2 -VASc score in COPD and non-COPD patients. 21,23,43,46,47,52,54 Patients with AF and COPD had a clinical history with more prevalent diabetes mellitus, CAD, CHF, and stroke (Table 4) than those without COPD. Furthermore, AF COPD patients were less likely to be female but were significantly older compared to non-COPD patients.…”