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International Journal of Arrhythmia 2017;0(0):
Chronic obstructive pulmonary disease increases the risk of new-onset atrial fibrillation and mortality of patients with atrial fibrillation
Shinjeong Song 1, Pil-Sung Yang 1, Tae-Hoon Kim 1, Jae-Sun Uhm 1, Hui-Nam Pak 1, Moon-Hyoung Lee 1, Boyoung Joung 1
Yonsei Cardiovascular Hospital, Seoul, Korea
Corresponding Author: Boyoung Joung ,Tel: 2-2228-8460, Fax: 2-2228-8460, Email: cby6908@yuhs.ac
Received: November 9, 2017.  Accepted: December 19, 2018.
Abstract
Background: Although few previous studies have analyzed the role of reduced lung function in predicting atrial fibrillation (AF), the relationship between the incidence of AF and comorbid chronic obstructive pulmonary disease (COPD) is unclear. We hypothesized that COPD is associated with the occurrence of new-onset AF and clinical outcomes in AF patients.
Methods: We analyzed the development of new-onset AF in 501,668 patients without AF and clinical outcomes in 4,541 patients with AF using Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC).
Results: 4.8% (11,442 of 501,668) of non AF patients and 18.6% (820 of 4,541) of AF patients had comorbid COPD. Over a follow-up period (45.5±14.9 months), the incidence of AF in COPD patients was significantly higher than that in non-COPD patients (2.6% vs. 0.6%, p<0.001). In a multivariate Cox regression analysis, COPD predicted higher risk of AF independently from other risk factors (HR: 1.41, 95% CI: 1.25-1.60, p<0.001). The all-cause mortality of the AF patients with COPD was significantly higher in patients who used b-blockers (20.6% vs 13.1% during follow-up, P <0.008). In a multivariate Cox regression analysis, COPD was still an independent risk factor for all-cause mortality (HR: 1.25, 95% CI: 1.03-1.51, p=0.022), and stroke HR: (1.19, 95% CI: 1.00-1.41, p=0.039).
Conclusions: The presence of COPD is an independent risk factor for new-onset AF. In AF patients, COPD is independently associated with all-cause mortality, and stroke.
Key Words: Atrial fibrillation; Chronic obstructive lung disease; Incidence; Mortality