Better management strategies are needed for patients with comorbid end-stage chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF), particularly in elderly patients, as the prevalence has increased in recent years, according to a study published in CHEST.

This retrospective analysis evaluating AF prevalence in hospital encounters with patients with end-stage COPD on home oxygen admitted for COPD exacerbations was conducted using 2003-2014 data from the Nationwide Inpatient Sample. All patients ≥18 on home oxygen with a primary COPD diagnosis who were admitted for COPD exacerbation were included for analysis. The associations between AF and cost, hospital outcomes, clinical factors, and length of stay were evaluated using multivariate-adjusted models.

Out of a total 1,345,270 patients, 18.2% (n=244,488) had AF, and the prevalence increased from 12.9% to 21.3% between 2003 and 2014, varying between sex, age, income, race, hospital region and insurance type (P <.0001). Increased odds of AF were associated with advancing age, white race, high income, female sex, and large hospital size. AF presence was associated with increased length of stay and cost, and was a risk predictor for stroke (odds ratio [OR],1.80; 95% CI, 1.40-2.32), sepsis (OR, 1.23; 95% CI, 1.10-1.37), acute kidney injury (OR, 1.09; 95% CI, 1.04-1.13), noninvasive mechanical ventilation (OR, 1.14; 95% CI, 1.09-1.18), invasive mechanical ventilation (OR, 1.37; 95% CI, 1.29-1.47), acute respiratory failure (OR, 1.09; 95% CI, 1.06-1.12), and in-hospital death (OR, 1.54; 95% CI, 1.45-1.65).

The investigators concluded, “As the largest publicly available all-payer database in the US, the [Nationwide Inpatient Sample] enabled us to comprehensively evaluate the prevalence, associated factors, and clinical outcomes of comorbid AF in patients with end-stage COPD. Our findings should prompt further efforts to identify the reasons for increased AF prevalence and provide better management strategies for end-stage COPD patients comorbid with AF.”


Xiao X, Han H, Wu C, et al. Prevalence of atrial fibrillation in hospital encounters with end-stage chronic obstructive pulmonary disease on home oxygen: national trends in the United States [published online January 23, 2019]. CHEST. doi:10.1016/j.chest.2018.12.021