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Original research article
Characteristics and outcomes of adults with chronic obstructive pulmonary disease and atrial fibrillation
  1. Michael T Durheim1,2,3,
  2. DaJuanicia N Holmes3,
  3. Rosalia G Blanco3,
  4. Larry A Allen4,
  5. Paul S Chan5,
  6. James V Freeman6,
  7. Gregg C Fonarow7,
  8. Alan S Go8,
  9. Elaine M Hylek9,
  10. Kenneth W Mahaffey10,
  11. Sean D Pokorney2,3,
  12. James A Reiffel11,
  13. Daniel E Singer12,
  14. Eric D Peterson2,3,
  15. Jonathan P Piccini2,3
  1. 1 Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  2. 2 Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
  3. 3 Duke Clinical Research Institute, Durham, North Carolina, USA
  4. 4 Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
  5. 5 Department of Cardiovascular Research, St. Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
  6. 6 Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  7. 7 Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
  8. 8 Division of Research, Kaiser Permanente, Oakland, California, USA
  9. 9 Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  10. 10 Department of Medicine, Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, California, USA
  11. 11 Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA
  12. 12 Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Michael T Durheim, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet, Oslo 0372, Norway; michael.durheim{at}duke.edu

Abstract

Objective Chronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes among patients with AF.

Methods We compared patients with and without a diagnosis of COPD in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, a prospective registry that enrolled outpatients with AF not secondary to reversible causes, from both academic and community settings.

Results Among 9749 patients with AF, 1605 (16%) had COPD. Relative to patients without COPD, those with COPD were more likely to be older, current/former smokers (73% vs 43%), have heart failure (54% vs 29%) and coronary artery disease (49% vs 34%). Oral anticoagulant and beta blocker use were similar, whereas digoxin use was more common among patients with COPD. Symptom burden was generally higher, and QoL worse, among patients with COPD (median Atrial Fibrillation Effect on QualiTy-of-Life score 76 vs 83). Patients with COPD had higher risk of all-cause mortality (adjusted HR 1.52 (95% CI 1.32 to 1.74)), cardiovascular mortality (adjusted HR 1.51 (95% CI 1.24 to 1.84)) and cardiovascular hospitalisation (adjusted HR 1.15 (95% CI 1.05 to 1.26)). Patients with COPD also had higher risk of major bleeding events (adjusted HR 1.25 (95% CI 1.05 to 1.50)). There did not appear to be associations between COPD and AF progression, ischaemic events or new-onset heart failure.

Conclusions Among patients with AF, COPD is associated with higher symptom burden, worse QoL, and worse cardiovascular and bleeding outcomes. These associations were not fully explained by cardiovascular risk factors, AF treatment or smoking history.

Clinical registration number NCT01165710

  • atrial fibrillation
  • quality and outcomes of care

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Footnotes

  • Contributors MTD, LAA, PSC, JVF, GCF, ASG, EMH, KWM, SDP, JAR, DES, EDP and JPP contributed to study design and interpretation of data. DNH performed the statistical analysis and contributed to interpretation of data. RGB contributed to study management and interpretation of data. All authors contributed to writing the manuscript and approved the final version. MTD and JPP took responsibility for the overall content as guarantors.

  • Funding ORBIT-AF was sponsored by Janssen Scientific Affairs, LLC (Raritan, NJ, USA).

  • Competing interests LAA reports personal fees from Novartis and from Janssen during the conduct of the study, grants from PCORI, grants from American Heart Association, grants from NIH and personal fees from Boston Scientific, outside the submitted work. PSC reports consulting fees from Optum Rx and from American Heart Association, and grants from NIH. JVF reports personal fees from American College of Cardiology and from the National Cardiovascular Data Registry, personal fees from Janssen Pharmaceuticals, and grants from NHLBI, outside the submitted work. GCF reports personal fees from Janssen and personal fees from Medtronic, outside the submitted work. ASG reports that he has received a research grant through his institution from iRhythm Technologies. EMH reports personal fees from Advisory Boards: Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Janssen, Medtronic, Pfizer and Portola; personal fees from honoraria for symposia: Bristol Myers Squibb, Boehringer Ingelheim, DOASENSE and Pfizer, outside the submitted work. KWM reports grants from Afferent, grants from Amgen, grants and personal fees from AstraZeneca, from Daiichi, grants from Ferring, grants from Google (Verily), grants and personal fees from Johnson & Johnson, grants from Medtronic, grants and personal fees from Merck, grants and personal fees from Novartis, grants from Sanofi, grants from St. Jude, personal fees from Ablynx, personal fees from BAROnova, from Bio2Medical, personal fees from Boehringer Ingelheim, personal fees from Bristol Myers Squibb, personal fees from Cardiometabolic Health Congress, personal fees from Cubist, personal fees from Eli Lilly, personal fees from Elsevier, personal fees from Epson, personal fees from Glaxo Smith Kline, personal fees from Mt. Sinai, personal fees from Myokardia, personal fees from Oculeve, personal fees from Portola, personal fees from Radiomeer, personal fees from Springer Publishing, personal fees from The Medicines Company, personal fees from Theravance, personal fees from UCSF, personal fees from Vindico, personal fees from WebMD, outside the submitted work. SDP reports grants from Janssen Pharmaceuticals, grants and personal fees from Bristol-Myers Squibb, grants and personal fees from Pfizer, grants from Food and Drug Administration, during the conduct of the study; grants and personal fees from Boston Scientific, personal fees from Medtronic, grants from Gilead, outside the submitted work. JAR reports grants from Janssen, during the conduct of the study; grants from Medtronic, personal fees from Portola, personal fees from Boehringer Ingelheim, outside the submitted work. DES reports personal fees from Johnson & Johnson, during the conduct of the study; grants from Bristol-Myers Squibb, grants from Boehringer Ingelheim, personal fees from Bristol-Myers Squibb, personal fees from Boehringer Ingelheim, personal fees from CVS Health, personal fees from Johnson & Johnson, personal fees from Merck, personal fees from Pfizer, personal fees from Medtronic, outside the submitted work. EDP reports grants and personal fees from Janssen Pharmaceuticals, outside the submitted work. JPP reports grants to his institution from ARCA Biopharma, Boston Scientific, Gilead Sciences, Janssen Pharmaceuticals, St. Jude Medical, and ResMed; consultancy fees from Amgen, Spectranetics, Medtronic, Allergan, Janssen Pharmaceuticals.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Institutional Review Board at Duke University and at all enrolling centres.

  • Provenance and peer review Commissioned; externally peer reviewed.

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