Chronic obstructive pulmonary disease in patients with atrial fibrillation: Insights from the ARISTOTLE trial

Characteristics and outcomes of adults with chronic obstructive pulmonary disease and atrial fibrillation

“…Beta blockers have historically been associated with concern for precipitating bronchoconstriction or ameliorating the effect of inhaled adrenergic agents in patients with COPD; indeed, in previous studies COPD has been associated with lower rates of beta blocker use among patients with HF 16–18. Similarly, patients with comorbid COPD were also less likely to be treated with beta blockers in both EORP-AF3 and in ARISTOTLE 7. While beta blocker use in ORBIT-AF stands in contrast to these prior findings, we did find several differences in treatment strategy, including higher rates of digoxin and calcium channel blocker use among patients with COPD as compared with patients without COPD.…”

“…As in our study, COPD was an independent risk factor for CV mortality among patients with AF enrolled in EORP-AF. COPD was also an important risk factor for mortality in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial7 and in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation study 6. In contrast to clinical trials, in which patients with higher comorbidity burden may be under-represented, the prevalence of COPD in ORBIT-AF was relatively higher at 16%.…”

“…In the general population, patients with COPD are at higher risk of cardiovascular (CV) morbidity and mortality than patients without COPD 4 5. Among patients with AF, COPD has been associated with all-cause6 and CV mortality7 in clinical trials, independent of other known risk factors. COPD is also associated with higher risk of major bleeding among patients with AF treated with anticoagulants in the context of clinical trials 8.…”

One-year and long-term mortality in patients hospitalized for chronic obstructive pulmonary disease

“…AF is the most common arrhythmia in the general population (59) and in patients with COPD, and the incidence of AF increases with decreasing FEV 1 (60). AF has an adverse impact on COPD prognosis and mortality (61); also, a recent study in patients with AF reported COPD to be independently associated with increased mortality from both cardiovascular and non-cardiovascular causes (62). The mechanism responsible for increased mortality in patients with AF and COPD seems not only related to the shared risk factors, such as tobacco use or age, but rather to thromboembolic events associated with FA and resulting from hypercoagulable states, and increased platelet aggregation, frequent in COPD (63,64), regardless of pulmonary HTN and prescribed treatment for underlying cardiovascular diseases (62).…”

Population‐level evaluation of complications after catheter ablation in patients with atrial fibrillation and heart failure

“…The ROCKET‐AF and ARISTOTLE trials have identified the chronic obstructive pulmonary disorder as a predictor of all‐cause mortality in the AF population. In addition, HAS‐BLED risk score has been identified as a predictor of long‐term adverse outcomes, including mortality, in the AF population as well as other cardiovascular diseases and postcardiac procedures …”