Clinical characteristics and prognostic significance of chronic obstructive pulmonary disease in patients with atrial fibrillation: results from a multicenter atrial fibrillation registry study

Objectives: Atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) are 2 common morbidities and often coexist. Studies have shown that COPD is a risk factor for cardiovascular disease, but the characteristics in patients with COPD and AF, as well as the impact of COPD on the outcomes of AF were lacking. The aim of present study was to analyze the clinical characteristics and to evaluate the association of COPD with 1-year outcomes in patients with AF.

Design: Longitudinal observational study.

Participants: A total of 1975 consecutive patients with AF were registered. Patients were divided into COPD group and non-COPD group according to whether AF coexisted with COPD.

Measurements: Outcome measures included all-cause mortality, stroke, and major adverse events (MAE) during 1-year follow-up.

Results: A group of 227 (11.5%) patients had concomitant COPD. Compared with non-COPD patients, patients with COPD were older and tended to have other coexisting cardiovascular morbidities, and had a significantly higher percentage of smoking history. Anticoagulation with warfarin was adopted by only a few patients both with and without COPD. During 1-year follow-up, the all-cause mortality and major adverse event rate in the COPD group were significantly higher than that of non-COPD group (26.9% vs 12.3%, P < .001 and 25.6% vs 19.1%, P = .027, respectively), whereas the incidence of stroke in the 2 groups was comparable (7.9% vs 7.4%, P = .788). Moreover, the cause-specific mortality between the 2 groups was comparable. After multivariate adjustments, COPD was still an independent risk factor for both 1-year all-cause mortality [hazard rate (HR) = 1.491, 95% confidence interval (CI) 1.110-2.002, P = .008] and cardiovascular mortality (HR = 1.595, 95% CI 1.071-2.376, P = .022), but not a risk factor for stroke (HR = 0.879, 95% CI 0.527-1.464, P = .620).

Conclusions: Anticoagulation treatment is inadequate in patients with AF and COPD. The presence of COPD in patients with AF is an independent risk factor for 1-year all-cause mortality and cardiovascular mortality but not a risk factor for stroke.