Risk of Cardiovascular Complications Is Higher for Patients With AF and COPD

Atrial fibrillation (AF) is among the most commonly observed extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD), and AF significantly impacts the risk of cardiovascular morbidity and mortality in patients with COPD, though the mechanisms underlying increased risk of vascular events and death associated with COPD and AF are not entirely understood.

One recent study used a cross-sectional analysis of a large cohort of patients with AF to investigate the relationship between COPD and AF, and to identify mediators of increased vascular risk; they found that the risk of cardiovascular complications is higher for patients with AF who also have COPD than it is for patients without COPD.

The study relied on data from the Umbria Atrial Fibrillation Registry, which includes patients with AF from 22 centers in Italy. In total, 2159 patients were included, and 15.6% of them had COPD as well as AF. Patients who had COPD along with AF were more likely to have obesity and to be current smokers. Other cardiovascular risk factors, such as diabetes and chronic kidney disease, as well as peripheral artery disease and subclinical atherosclerosis, were also more prevalent in patients with COPD.

Those who had COPD also had a higher prevalence of previous acute coronary syndrome, stroke/transient ischemic attack, and heart failure. Most notably, those with COPD had a much higher frequency of heart failure requiring hospitalization than those without COPD (40.9% versus 17.4%; P =.0001).

Also of note was the fact that 24.0% of patients with COPD had a history of anemia, versus 14.0% for those without COPD. Thromboembolic and bleeding risks were also higher in the COPD group.

Finally, patients with COPD were also more likely to have left ventricular hypertrophy than those without COPD (P = .018).

“Results of our cross-sectional analysis highlighted the notion that AF patients with COPD have a higher risk of cardio- and cerebrovascular complications than AF patients without this lung disease,” wrote the investigators. The results of the analysis suggest that early intervention for patients with COPD and AF should be implemented as a matter of urgency, they added.

Reference

Angeli F, Reboldi G, Trapasso M, Aita A, Ambrosio G, Verdecchia P. Detrimental impact of chronic obstructive pulmonary disease in atrial fibrillation: new insights from Umbria Atrial Fibrilation Registry. Medicina. 2019;55(7):358. doi: 10.3390/medicina55070358.