Chronic obstructive pulmonary disease predicts higher incidence and in hospital mortality for atrial fibrillation. An observational study using hospital discharge data in Spain (2004-2013)

Abstract

Background: Our objectives were to describe and compare trends in the incidence of hospitalization for atrial fibrillation (AF) in patients with and without chronic obstructive pulmonary disease (COPD) in Spain during 2004-2013 and to assess the effect of COPD on the in-hospital mortality (IHM) of patients with AF.

Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database. The study population comprised patients≥40years with a primary diagnosis of AF. We grouped admissions by COPD status. We selected one age- and sex-matched control for each COPD case. The clinical characteristics, CHA2DS2-VASc score, diagnostic and therapeutic procedures, length of hospital stay (LOHS) and in-hospital-mortality (IHM) were analyzed.

Results: We identified 210,605 admissions for AF (17.0% with COPD). Over time, the prevalence of COPD was stable among men and increased significantly among women. The incidence of admissions for AF during the study period was higher in COPD patients than in non-COPD patients (men, 2.36-fold [95%CI, 2.33-2.40] vs. 1.59-fold [95%CI, 1.56-1.61]). Comorbidities, LOHS and IHM were more common in patients with COPD (2.93% vs. 2.23%, p<0.05). Atrial cardioversion, catheter ablation, and pacemaker implantation were significantly more frequent in non-COPD patients. COPD was associated with higher IHM after admission for AF (OR, 1.14; 95%CI, 1.03-1.26).

Conclusions: COPD is a very frequent comorbidity in patients hospitalized for AF. The incidence of admissions for AF during the study period was twice as high in patients with COPD than in those without. The presence of COPD during hospitalization for AF increases LOHS and IHM.