Department of Emergency Medicine, Massachusetts General Hospital, Boston (A.H., T.G., M.K.F., C.A.C., K.H.).
Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (Y.J.S.).
Circ Arrhythm Electrophysiol. 2018 Sep;11(9):e006322. doi: 10.1161/CIRCEP.118.006322.
Background Although emerging evidence has suggested the relationship of chronic obstructive pulmonary disease with atrial fibrillation (AF), little is known about whether acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of repeated AF-related healthcare utilization. Methods This is a self-controlled case series study using the population-based emergency department (ED) and inpatient databases of 5 US states from 2007 through 2012. Among patients with existing AF, we identified patients with an AECOPD hospitalization and at least 1 ED visit or hospitalization for AF during the observation period. We constructed conditional Poisson regression models to compare the rate of AF-related ED visits or hospitalizations during sequential 90-day periods after the AECOPD hospitalization, with pre-AECOPD days 1 to 90 as the reference. Results We analyzed 944 patients who were hospitalized for AECOPD and had an ED visit or hospitalization for AF during a 450-day period. The median age was 77 years, and 41% were men. Compared with the reference period, the rate of AF-related ED visits or hospitalizations significantly increased in the post-AECOPD days 1 to 90 (7.3 versus 14.1 per 100 person-months; rate ratio, 1.93; 95% CI, 1.63-2.29; P<0.001). Then, the rate decreased to the reference level in the post-AECOPD days 91 to 180 (7.5 per 100 person-months; rate ratio, 1.03; 95% CI, 0.85-1.25; P=0.77) and remained at the reference level during post-AECOPD days 181 to 270 (rate ratio, 0.84; 95% CI, 0.68-1.03; P=0.09) and days 271 to 360 (rate ratio, 0.90; 95% CI, 0.73-1.10; P=0.29). These temporal associations persisted with stratification by age, sex, and season. Conclusions Among patients with existing AF, AECOPD was associated with a higher risk of AF-related ED visit or hospitalization in the first 90-day post-AECOPD period.
尽管有新的证据表明慢性阻塞性肺疾病(COPD)与心房颤动(AF)有关,但对于 COPD 急性加重(AECOPD)是否会增加反复 AF 相关医疗保健利用的风险知之甚少。
这是一项使用 2007 年至 2012 年 5 个美国州的基于人群的急诊(ED)和住院数据库的自我对照病例系列研究。在存在 AF 的患者中,我们确定了 AECOPD 住院患者和观察期间至少有一次 ED 就诊或 AF 住院的患者。我们构建了条件泊松回归模型,以比较 AECOPD 住院后连续 90 天内 AF 相关 ED 就诊或住院的发生率,以 AECOPD 前 90 天(1-90 天)为参考。
我们分析了 944 名因 AECOPD 住院且在 450 天内因 AF 就诊或住院的患者。中位年龄为 77 岁,41%为男性。与参考期相比,AECOPD 后 1-90 天 AF 相关 ED 就诊或住院的发生率显著增加(每 100 人-月 7.3 次与 14.1 次;发生率比,1.93;95%CI,1.63-2.29;P<0.001)。然后,AECOPD 后 91-180 天的发生率降至参考水平(每 100 人-月 7.5 次;发生率比,1.03;95%CI,0.85-1.25;P=0.77),AECOPD 后 181-270 天(发生率比,0.84;95%CI,0.68-1.03;P=0.09)和 271-360 天(发生率比,0.90;95%CI,0.73-1.10;P=0.29)的发生率保持在参考水平。这些时间关联在按年龄、性别和季节分层时仍然存在。
在存在 AF 的患者中,AECOPD 与 AECOPD 后第一个 90 天内 AF 相关 ED 就诊或住院的风险增加有关。