Chronic Obstructive Pulmonary Disease Increases the Risk of New-onset Atrial Fibrillation and Mortality of Patients with Atrial Fibrillation

Background: Although a 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: Comorbid COPD was found in 4.8% (11,442 of 501,668) of non-AF patients and 18.6% (820 of 4,541) of AF patients. The incidence of AF in COPD patients was significantly higher compared to non-COPD patients (2.6% vs. 0.6%, p<0.001) over the follow-up period (45.514.9 months). 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 allcause mortality of AF patients with COPD was significantly higher in patients who used b-blockers (20.6% vs 13.1% during follow-up, p<0.008). Multivariate Cox regression analysis showed that COPD is 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).