Risk of Death and Cardiovascular Events in Asian Patients With Atrial Fibrillation and Chronic Obstructive Pulmonary Disease: A Report From the Prospective APHRS Registry
Authors: Bucci Tommaso , Romiti Giulio Francesco , Shantsila Alena , Teo Wee‐Siong , Park Hyung‐Wook , Shimizu Wataru , Corica Bernadette , Proietti Marco , Tse Hung‐Fat , Chao Tze‐Fan , Frost Frederick , Lip Gregory Y. H. , David Chun‐Wah Siu , Shimizu Wataru , Yodogawa Kenji , Tsutsui Hiroyuki , Mukai Yasushi , Tomita Hirofumi , Horiuchi Daisuke , Hagii Joji , Aonuma Kazutaka , Okumura Yasuo , Goya Masahiko , Hirao Kenzo , Hagiwara Nobuhisa , Suzuki Atsushi , Yamane Teiichi , Ikeda Takanori , Yuzawa Hitomi , Satomi Kazuhiro , Yazaki Yoshinao , Fukuda Keiichi , Kobayashi Yoshinori , Morita Norishige , Murohara Toyoaki , Watanabe Eiichi , Harada Masahide , Sakagami Satoru , Saeki Takahiro , Kusano Kengo , Miyamoto Koji , Miyazaki Shinsuke , Tada Hiroshi , Inoue Koichi , Tanaka Nobuaki , Koretsune Yukihiro , Abe Haruhiko , Kihara Yasuki , Nakano Yukiko , Shimizu Akihiko , Yoshiga Yasuhiro , Sakamoto Tomohiro , Okumura Ken , Takahashi Naohiko , Shinohara Tetsuji , Soejima Kyoko , Takagi Masahiko , Kawamura Mitsuharu , Munetsugu Yumi , Kim Sung‐Hwan , Shim Jae‐Min , Uhm Jae Sun , Im Sung Il , Par Hyoung‐Seob , Kim Jun Hyung , On Young Keun , Oh Il‐Young , Shin Seung Yong , Ko Jum Suk , Park Jun Beom , Teo Wee‐Siong , Wong Kelvin Cheok‐Keng , Lim Toon‐Wei , Foo David , Chen Shih‐Ann , Chen Shih‐Ann , Chao Tze‐Fan , Lin YennJiang , Chung Fa‐Po , Hu Yu‐Feng , Chang Shil‐Lin , Tuan Ta‐Chuan , Liao Jo‐Nan , Li Cheng‐Hung , Huang Jin‐Long , Hsieh Yu‐Cheng , Wu Tsu‐Juey , Liao Ying‐Chieh , Chiang Cheng‐Hung , Hsiao Hsiang‐Chiang , Yeh Tung‐Chen , Lin Wei‐Siang , Lin Wen‐Yu , Kuo Jen‐Yuan , Hong Chong‐Lie , Wu Yih‐Je , Li Ying‐Siang , Tsai Jui‐Peng , Sung Kuo‐Tzu , Chang Sheng‐Hsiung 
Published: March 2024

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
.