Liverpool Centre of Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK.
Department of General and Specialized Surgery Sapienza University of Rome Rome Italy.
J Am Heart Assoc. 2024 Apr 2;13(7):e032785. doi: 10.1161/JAHA.123.032785. Epub 2024 Mar 27.
Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of adverse events in patients with atrial fibrillation (AF); however, few data are available on this topic in Asian populations.
Prospective observational study conducted on patients with AF enrolled in the Asia-Pacific Heart Rhythm Society (APHRS) AF Registry. The diagnosis of COPD was based on data reported in the case report form by the investigators. Cox-regression models were used to assess the 1-year risk of a primary composite outcome of all-cause death, thromboembolic events, acute coronary syndrome, and heart failure. Analysis on single outcomes and cardiovascular death was also performed. Interaction analysis was used to assess the risk of composite outcome and all-cause death in different subgroups. The study included 4094 patients with AF (mean±SD age 68.5±12 years, 34.6% female), of whom 112 (2.7%) had COPD. Patients with COPD showed a higher incidence of the primary composite outcome (25.1% versus 6.3%, <0.001), all-cause death (14.9% versus 2.6%, <0.001), cardiovascular death (2.0% versus 0.6%, <0.001), and heart failure (8.3% versus 6.0%, <0.001). On multiple Cox-regression analysis, COPD was associated with a higher risk of the primary composite outcome (hazard ratio [HR], 3.17 [95% CI, 2.05-4.90]), all-cause death (HR, 3.59 [95% CI, 2.04-6.30]), and heart failure (HR, 3.32 [95% CI, 1.56-7.03]); no statistically significant differences were found for other outcomes. The association between COPD and mortality was significantly modified by the use of beta blockers (=0.018).
In Asian patients with AF, COPD is associated with worse prognosis. In patients with AF and COPD, the use of beta blockers was associated with a lower mortality.
clinicaltrials.gov Identifier: NCT04807049.
慢性阻塞性肺疾病（COPD）与心房颤动（AF）患者不良事件的风险增加相关；然而，亚洲人群中关于这一主题的数据很少。
在亚太心律学会（APHRS）AF 登记处纳入的 AF 患者中进行了前瞻性观察性研究。COPD 的诊断是基于研究者在病例报告表中报告的数据。Cox 回归模型用于评估全因死亡、血栓栓塞事件、急性冠脉综合征和心力衰竭的主要复合结局的 1 年风险。还对单一结局和心血管死亡进行了分析。交互分析用于评估不同亚组中复合结局和全因死亡的风险。该研究纳入了 4094 例 AF 患者（平均年龄 68.5±12 岁，34.6%为女性），其中 112 例（2.7%）患有 COPD。COPD 患者的主要复合结局（25.1%比 6.3%，<0.001）、全因死亡（14.9%比 2.6%，<0.001）、心血管死亡（2.0%比 0.6%，<0.001）和心力衰竭（8.3%比 6.0%，<0.001）发生率更高。在多变量 Cox 回归分析中，COPD 与主要复合结局（危险比 [HR]，3.17 [95%置信区间，2.05-4.90]）、全因死亡（HR，3.59 [95%置信区间，2.04-6.30]）和心力衰竭（HR，3.32 [95%置信区间，1.56-7.03]）的风险增加相关；其他结局无统计学差异。COPD 与死亡率之间的关联因β受体阻滞剂的使用而发生显著改变（=0.018）。
在亚洲 AF 患者中，COPD 与预后较差相关。在 AF 和 COPD 患者中，β受体阻滞剂的使用与死亡率降低相关。
临床试验.gov 标识符：NCT04807049。
