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Better strategies needed to manage patients hospitalized with COPD, atrial fibrillation

The prevalence of atrial fibrillation increased in the United States from 2003 to 2014 among patients hospitalized with end-stage chronic obstructive pulmonary disease, according to results of a retrospective analysis.

“Better management strategies for patients with end-stage COPD comorbid with [atrial fibrillation] are needed, especially in elderly individuals,” Xiaochun Xiao, MPH, researcher in the department of health statistic at Second Military Medical University in Shanghai, and colleagues wrote in Chest.

Researchers evaluated data from 1,345,270 patients included in the 2003 to 2014 Nationwide Inpatient Sample — the largest U.S.-based, publicly available all-payer inpatient care database including data on more than 7 million annual hospital stays. Xiao and colleagues assessed the prevalence of atrial fibrillation (AF) in patients with end-stage COPD on home oxygen admitted for COPD exacerbation. Multivariate-adjusted models were used to evaluate the association of AF with clinical factors, cost, length of hospital stay and hospital outcomes.

Of all patients admitted for COPD exacerbation, 18.2% had AF.

The primary outcome — temporal trend of AF prevalence — increased from 12.9% in 2003 to 21.3% in 2014 (P < .0001).

Patients with AF were more likely to be older (75.5 vs. 69.6 years; P < .0001), white (80.9% vs. 74.4%; P < .0001) and male (59.1% vs. 50.7%; P < .0001) compared with those without AF.

Comorbidities associated with increased prevalence of AF included congestive heart failure, valvulopathy, pulmonary circulation, chronic blood anemia and coagulopathy.

In other findings, AF was associated with increased health care costs and hospital length of stay. Additionally, AF was a risk predictor for stroke (OR = 1.8; 95% CI, 1.4-2.32), in-hospital death (OR = 1.54; 95% CI, 1.45-1.65), invasive mechanical ventilation (OR = 1.37; 95% CI, 1.29-1.47), sepsis (OR = 1.23; 95% CI, 1.1-1.37), noninvasive mechanical ventilation (OR = 1.14; 95% CI, 1.09-1.18), acute respiratory failure (OR = 1.09; 95% CI, 1.06-1.12) and acute kidney injury (OR = 1.09; 95% CI, 1.04-1.13).

“Our study represents the most current assessment of temporal trends and characteristics of AF among hospital encounters in the United States with end-stage COPD on home oxygen who were hospitalized for COPD exacerbation,” the researchers wrote. “Our findings should prompt further efforts to identify the reasons for increased AF prevalence and provide better management strategies for patients with end-stage COPD comorbid with AF.” – by Jennifer Southall

Disclosures: The authors report no relevant financial disclosures.