In patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbation, the presence of atrial fibrillation may increase the risk of in-hospital mortality, according to study results published in Journal of Atrial Fibrillation.

Investigators indicated that COPD-related atrial fibrillation is associated with worse outcomes and symptom burden compared with atrial fibrillation cases without COPD; however, there is little evidence about the effect of atrial fibrillation on patients who are hospitalized for COPD exacerbation. The objective of this study was to examine mortality rates and hospital costs associated with atrial fibrillation in patients hospitalized for COPD exacerbation.

The researchers used discharge records from the National Inpatient Sample database to examine patients aged 18 years and older who were hospitalized for COPD exacerbation between 2012 and 2014. Patient records were divided into 2 groups (with or without atrial fibrillation), and propensity score matching analysis based on demographic and clinical scores was used to ensure adequately balanced groups. The primary outcome was inpatient mortality, and secondary outcomes were prolonged length of stay (defined as ≥8 days) and high total charges (defined as ≥$54,785) for patients with COPD exacerbation. The researchers compared baseline characteristics and outcomes between both groups of patients.

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Findings revealed that in 1,377,795 patients discharged with COPD exacerbation, 45,769 (16.6%) had atrial fibrillation. Patients with atrial fibrillation were older and had a greater number of comorbidities than those without atrial fibrillation, as well as a higher mortality rate (2.4% vs 1%, respectively, P <.001). After adjusting for age, sex, and confounders, multivariable regression analysis showed that atrial fibrillation was associated with higher in-hospital mortality (adjusted odds ratio [aOR], 1.46; 95% CI, 134-1.59; P <.001), prolonged length of stay (aOR, 1.63; 95% CI, 1.57-1.69; P <.001), and higher costs (aOR, 1.45; 95% CI, 1.40-1.49; P <.001).

This study had several limitations. Atrial fibrillation was not characterized into subtypes (eg, new onset, paroxysmal, or permanent), and the analysis did not take certain variables into account including heart rate, blood pressure, and medication use. In addition, coding practices may have differed among the hospitals that participated in this study creating some inconsistencies, and data entries in the database used were discharge level, and there may have been duplications.

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The researchers noted that their study is one of the few that has examined the effect of atrial fibrillation on in-hospitality mortality in COPD specifically. “Our findings may suggest that there is an opportunity to look at AF as a detrimental event in COPD exacerbation,” they wrote. “Whether or not a tailored management approach is of prognostic value remains to be studied.”


Abdullah AS, Eigbire G, Ali M, et al. Relationship of atrial fibrillation to outcomes in patients hospitalized for chronic obstructive pulmonary disease exacerbation. J Atr Fibrillation. 2019;12(2):2117.

This article originally appeared on Pulmonology Advisor