Risk factors for new-onset atrial fibrillation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Abstract

Background New-onset atrial fibrillation (AF) in patients with chronic obstructive pulmonary disease (COPD) is associated with an accelerated decline in lung function, and a significant increase in mortality rate. A deeper understanding of the risk factors for new-onset AF during COPD will provide insights into the relationship between COPD and AF and guide clinical practice. This systematic review and meta-analysis is designed to identify risk factors for new-onset AF in patients with COPD, and to formulate recommendations for preventing AF in COPD patients that will assist clinical decision making. Methods PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies, which reported the results of potential risk factors for new-onset AF in COPD patients. Results Twenty studies involving 8,072,043 participants were included. Fifty factors were examined as potential risk factors for new-onset AF during COPD. Risk factors were grouped according to demographics, comorbid conditions, and COPD- and cardiovascular-related factors. In quantitative analysis, cardiovascular- and demographic-related factors with a greater than 50% increase in the odds of new-onset AF included age (over 65 years and over 75 years), acute care encounter, coronary artery disease, heart failure and congestive heart failure. Only one factor is related to the reduction of odds by more than 33.3%, which is black race (vs white). In qualitative analysis, the comparison of the risk factors was conducted between COPD-associated AF and non-COPD-associated AF. Cardiovascular-related factors for non-COPD-associated AF were also considered as risk factors for new-onset AF during COPD; however, the influence tended to be stronger during COPD. In addition, comorbid factors identified in non-COPD-associated AF were not associated with an increased risk of AF during COPD. Conclusions New-onset AF in COPD has significant demographic characteristics. Older age (over 65 years), males and white race are at higher risk of developing AF. COPD patients with a history of cardiovascular disease should be carefully monitored for new-onset of AF, and appropriate preventive measures should be implemented. Even patients with mild COPD are at high risk of new-onset AF. This study shows that risk factors for new-onset AF during COPD are mainly those associated with the cardiovascular-related event and are not synonymous with comorbid factors for non-COPD-associated AF. The pathogenesis of COPD-associated AF may be predominantly related to the cardiac dysfunction caused by the chronic duration of COPD, which increases the risk of cardiovascular-related factors and further increases the risk of AF during COPD. PROSPERO registration number CRD42019137758.

Frequency of Atrial Fibrillation in Patients Presenting With Decompensated Heart Failure

“…However, AF was less common among patients with a previous history of stroke, CABG, or PCI. Other studies have confirmed that these comorbidities are associated with adverse clinical outcomes due to atrial stiffness, vasoconstrictions, and inflammation [ 17 , 18 ]. Kazeminia et al reported that diabetes was the most common comorbidity among patients with heart failure, and the prevalence increases over time [ 19 ].…”

Impact of COPD or Asthma on the Risk of Atrial Fibrillation: A Systematic Review and Meta-Analysis

“…For example, some targeted treatments and medication usages will be emphasized in the novel handbook of COPD (and asthma) management. Some independent studies have substantially identified the increased cardiovascular risks in patients with COPD and asthma, and some associated evidence was provided by retrievable researches and reviews ( 9 , 10 ). However, no previous study provided enough quantitative synthesis evidence to identify the magnitude of the increased AF risk among patients with COPD or asthma.…”

“…Romiti et al ( 9 ) reported that COPD was prevalent in 13% of patients with AF, and was associated with increased adverse effects, the burden of management, and poorer prognosis, with double times the possibility of all-cause death and death of cardiovascular diseases and major bleeding. Based on the study of Huang Q et al ( 10 ) various characteristics serve as the risk factors for AF development, such as older age, males, and white race. In the study of Lee et al ( 7 ), the progression and recurrence of AF were independently influenced by COPD, and the outcomes of COPD patients with AF were worsened than those of people with sinus rhythm.…”

Peer Review #1 of "Obesity phenotypes and their relationships with atrial fibrillation (v0.1)"

“…Cox regression models were constructed to calculate the multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of the incidence of Afib for each metabolic obesity phenotype compared to the MHNW group. Possible confounding factors according to general principles and reviews of previous studies (Feng et al 2019;Huang et al 2020;Kwon et al 2019;Lee et al 2017;Nystrom et al 2015;Vyssoulis et al 2013) were selected. Model 1 was adjusted for sex and age; model 2 was adjusted for all model 1 variables plus current smoking status, alcohol use, and regular exercise; model 3 was adjusted for all model 2 variables plus marital status, education level, and average monthly income.…”