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COPD increases mortality among individuals with atrial fibrillation

A diagnosis of COPD independently increased risk for cardiovascular and non-cardiovascular mortality among patients with atrial fibrillation, according to study results.

COPD is associated with poor outcomes among patients with cardiovascular disease; however, prior research has not established whether COPD influences the risks for stroke or mortality among those with atrial fibrillation, according to study background.

Michael T. Durheim, MD, of the division of pulmonary, allergy and critical care medicine at Duke University Medical Center in Durham, N.C., and colleagues evaluated data from 18,134 participants in the ARISTOTLE trial, which compared the effects of apixaban (Eliquis; Bristol-Myers Squibb, Pfizer) and warfarin on the risk for systemic embolism or stroke.

All participants had atrial fibrillation and available pulmonary disease history.

Durheim and colleagues used Cox proportional hazards models to assess the associations between comorbid COPD and risks for stroke, systemic embolism or mortality. They adjusted for treatment allocation, as well as smoking history and other risk factors.

Researchers identified COPD in 1,950 (10.7%) members of the cohort.

Multivariable adjustment showed COPD was not associated with risk for systemic embolism or stroke (adjusted HR = 0.85; 95% CI, 0.6-1.21). However, COPD did appear associated with greater risk for all-cause mortality (adjusted HR = 1.6; 95% CI, 1.36-1.88), as well as both cardiovascular and non-cardiovascular mortality.

The benefit of apixaban compared with warfarin on systemic embolism or stroke appeared consistent among patients with COPD (HR = 0.92; 95% CI, 0.52-1.63) and without COPD (HR = 0.78; 95% CI, 0.65-0.95).

“COPD was independently associated with increased risk of cardiovascular and non-cardiovascular mortality among patients with atrial fibrillation, but was not associated with risk of stroke or systemic embolism,” Durheim and colleagues wrote. “The effect of apixaban on stroke or systemic embolism in COPD patients was consistent with its effect in the overall trial population.”  – by Jeff Craven

Disclosure: The ARISTOTLE trial was sponsored by Bristol-Myers Squibb and Pfizer.