Impact of Chronic Obstructive Pulmonary Disease in Patients with Atrial Fibrillation. An Analysis from the GLORIA-AF Registry

Aims: Chronic Obstructive Pulmonary Disease (COPD) may influence management and prognosis of Atrial Fibrillation (AF), but this relationship has been scarcely explored in contemporary global cohorts. We aimed to investigate the association between AF and COPD, in relation to treatment patterns and major outcomes. Methods: From the prospective, global GLORIA-AF Registry, we analysed factors associated with COPD diagnosis, as well as treatment patterns and risk of major outcomes in relation to COPD. Primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). Results: 36,263 patients (mean age 70.1±10.5 years, 45.2% females) were included; 2,261 (6.2%) had COPD. Prevalence of COPD was lower in Asia, and higher in North America. Age, female sex, smoking, BMI, and cardiovascular comorbidities were associated with presence of COPD. COPD was associated with higher use of OAC (adjusted Odds Ratio [aOR] and 95% Confidence Interval [CI]: 1.29 [1.13-1.47]), and higher OAC discontinuation (adjusted Hazard Ratio [aHR] and 95%CI: 1.12 [1.01-1.25]). COPD was associated with less use of beta-blocker (aOR [95%CI]: 0.79 [0.72-0.87]), amiodarone and propafenone, and higher use of digoxin and verapamil/diltiazem. Patients with COPD had higher hazard of primary composite outcome (aHR [95%CI]: 1.78 [1.58-2.00]); no interaction was observed regarding beta-blocker use. COPD was also associated with all-cause death (aHR [95%CI]: 2.01 [1.77-2.28]), MACEs (aHR [95%CI]: 1.41 [1.18-1.68]) and major bleeding (aHR [95%CI]: 1.48 [1.16-1.88]). Conclusions: In AF patients, COPD was associated with differences in OAC treatment and use of drugs. AF/COPD patients had worse outcomes, including higher mortality, MACE and major bleeding.