Atrial fibrillation and chronic obstructive pulmonary disease:diagnostic sequence and mortality risk

BACKGROUND AND AIMS: Chronic obstructive pulmonary disease (COPD) is present in 13% of atrial fibrillation (AF) patients. In patients diagnosed with both AF and COPD, we aimed to assess overall mortality risk and its association with temporal sequence in AF and COPD diagnosis.METHODS: This nationwide study assessed all patients aged 18-85 years diagnosed with both COPD and AF between 1999 and 2018 in Denmark. Three groups were defined according to the temporal sequence of diagnosis: COPD diagnosed at least 6 months before AF (COPD-First), AF diagnosed at least 6 months before COPD (AF-First) and COPD and AF diagnosed within a 6-months' time frame (AF∼COPD).RESULTS: We included 62 806 patients (75.0 years; 56.5% males). After 5 years of follow-up, 31 494 (50.1%) died. Mortality was highest in the COPD-First group (COPD-First: 52.8%; AF-First: 46.0%; AF∼COPD 50.6%). In a multivariable Cox-regression model adjusted for age, sex, type 2 diabetes, history of acute myocardial infarction, cancer, chronic kidney disease, and stroke, the AF∼COPD group (HR 1.14, 95%CI 1.11-1.17; P < 0.0001) and COPD-First group (HR 1.26, 95%CI 1.23-1.29; P < 0.0001) had a higher risk of death compared to the AF-First group. A restricted cubic spline analysis showed that the earlier the COPD was diagnosed, the worse the prognosis.CONCLUSIONS: Patients with concomitant AF and COPD had a very poor prognosis and the temporal sequence in diagnosis was differentially associated with prognosis, where a COPD diagnosis preceding an AF diagnosis was accompanied with a higher mortality risk compared to a COPD diagnosis following an AF diagnosis.