A systematic literature review and meta-analysis on the impact of COPD on atrial fibrillation patient outcome
Jiale Ye, Pingli Yao, Xuefei Shi, Xiaojun Yu
Abstract
BACKGROUND: COPD is often accompanied by extra-pulmonary manifestations such as thrombo-embolic and hemorrhagic events, the disease is linked with atrial fibrillation (AF). OBJECTIVE: The objective of the current review was to assess the impact of chronic obstructive pulmonary disease (COPD) on outcomes of atrial fibrillation (AF). METHODS: PubMed, Scopus, Embase, and Web of Science databases were searched for studies comparing overall mortality, cardiovascular death, and other outcomes for AF patients with and without COPD. The data retrieved were subjected to both qualitative and quantitative analyses. The hazard ratios (HR) obtained for mortality in presence of COPD were pooled to meta-analyze using generic inverse variance function of RevMan 5.3 software. The association of various risk factors and HRs were pooled with 95% confidence interval (CI). The quality of the included studies was assessed using Newcastle Ottawa scale (NOS). RESULTS: The hazard ratios (HR) were calculated with 95% confidence intervals (CIs). A total of seven studies were included. The pooled HR for the impact of COPD on overall mortality and cardiovascular mortality in AF patients was found to be 1.70 (95% CI: 1.47, 1.97; p<0.0001) and 1.80 (95% CI: 1.29, 2.52; p = 0.0005), respectively. Hemorrhagic events were significantly higher in AF patients with COPD (Odds ratio (OR): 1.84; 95% CI: 1.58, 2.14; p<0.00001). CONCLUSION: COPD has a deleterious impact on AF progression in terms of overall mortality, cardiovascular death, stroke and hemorrhagic complications.