Risk of Death and Cardiovascular Events in Asian Patients With Atrial Fibrillation and Chronic Obstructive Pulmonary Disease: A Report From the Prospective APHRS Registry
Tommaso Bucci, Giulio Francesco Romiti, Alena Shantsila, Wee‐Siong Teo, Hyung Wook Park, Wataru Shimizu, Bernadette Corica, Marco Proietti, Hung‐Fat Tse, Tze‐Fan Chao, Frederick Frost, Gregory Y.H. Lip, Chun‐Wah Siu David, Wataru Shimizu, Kenji Yodogawa, Hiroyuki Tsutsui, Yasushi Mukai, Hirofumi Tomita, Daisuke Horiuchi, Joji Hagii, Kazutaka Aonuma, Yasuo Okumura, Masahiko Goya, Kenzo Hirao, Nobuhisa Hagiwara, Atsushi Suzuki, Teiichi Yamane, Takanori Ikeda, Hitomi Yuzawa, Kazuhiro Satomi, Yoshinao Yazaki, Keiichi Fukuda, Yoshinori Kobayashi, Norishige Morita, Toyoaki Murohara, Eiichi Watanabe, Masafumi Harada, Satoru Sakagami, Takahiro Saeki, Kengo Kusano, Koji Miyamoto, Shinsuke Miyazaki, Hiroshi Tada, Koichi Inoue, Nobuaki Tanaka, Yukihiro Koretsune, Haruhiko Abe, Yasuki Kihara, Yukiko Nakano, Akihiko Shimizu, Yasuhiro Yoshiga, Tomohiro Sakamoto, Ken Okumura, Naohiko Takahashi, Tetsuji Shinohara, Kyoko Soejima, Masahiko Takagi, Mitsuharu Kawamura, Yumi Munetsugu, Sung‐Hwan Kim, Jaemin Shim, Jae‐Sun Uhm, Sung Il Im, Hyoung‐Seob Par, Jun Hyung Kim, Young Keun On, Il‐Young Oh, Seung Yong Shin, Jum Suk Ko, Jun Beom Park, Wee‐Siong Teo, Kelvin Cheok‐Keng Wong, Toon‐Wei Lim, David Foo, Shih‐Ann Chen, Shih‐Ann Chen, Tze‐Fan Chao, Yenn‐Jiang Lin, Fa‐Po Chung, Yu‐Feng Hu, Shil‐Lin Chang, Ta‐Chuan Tuan, Jo‐Nan Liao, Cheng‐Hung Li, Jin‐Long Huang, Yu‐Cheng Hsieh, Tsu‐Juey Wu, Ying‐Chieh Liao, Cheng‐Hung Chiang, Hsiang‐Chiang Hsiao, Tung‐Chen Yeh, W. D. Lin, Wen‐Yu Lin, Jen‐Yuan Kuo, C.‐J. Hong, Y. Wu, Ying‐Siang Li, Jui‐Peng Tsai, Kuo‐Tzu Sung, Sheng‐Hsiung Chang
Abstract
Background 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. Methods and Results 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%, P <0.001), all‐cause death (14.9% versus 2.6%, P <0.001), cardiovascular death (2.0% versus 0.6%, P <0.001), and heart failure (8.3% versus 6.0%, P <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 ( P int =0.018). Conclusions 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. Registration Information clinicaltrials.gov Identifier: NCT04807049 .