Emerging evidence suggests a heightened risk of heart failure (HF) and atrial fibrillation/ flutter (AF) following COPD exacerbations, particularly within the initial month post exacerbation. However, the precise clinical characteristics of people prone to HF or AF after COPD exacerbations remain elusive.
“Few studies have examined factors associated with hospitalization for incident AF after an exacerbation, with the focus on the short-term,” wrote Emily L. Graul and colleagues in a paper published in BMC Pulmonary Medicine. “Studies have investigated COPD progression in HF and conversely, HF progression across COPD phenotypes, but few have focused on exacerbating COPD alone and no studies have examined factors associated with hospitalization with a HF diagnosis following a COPD exacerbation.”
To bridge these gaps, the researchers explored factors associated with hospitalizations due to HF or AF following COPD exacerbations. Leveraging primary care EHRs from 2014 to 2020, linked to various databases, the researchers conducted two nested case-control studies. The cases included patients hospitalized for HF or AF within 30 days of a COPD exacerbation, with controls matched a general practitioner.
The analysis unveiled several demographic and clinical factors associated with HF and AF hospitalization. The following factors were significant predictors of HF hospitalization (1,569 cases, 3,138 controls):
❯ age
❯ type 2 diabetes
❯ obesity
❯ prior HF and arrhythmia history
❯ exacerbation severity
❯ cardiovascular medications
❯ airflow obstruction
❯ dyspnea severity
❯ chronic kidney disease
Severe exacerbations (aOR, 6.25; 95% CI, 5.10- 7.66), prior HF (aOR, 2.57; 95% CI, 1.73-3.83), age 80 and older (aOR, 2.41; 95% CI, 1.88-3.09), and diuretic prescriptions (aOR, 2.81; 95% CI, 2.29-3.45) exhibited the strongest associations.
Similarly, AF hospitalization (841 cases, 2,523 controls) was linked to:
❯ age
❯ male sex
❯ severe exacerbations
❯ arrhythmia
❯ pulmonary hypertension history
❯ cardiovascular medications Researchers observed the most robust associations for severe exacerbations (aOR, 5.78; 95% CI, 4.45-7.50), advanced age (aOR, 3.15; 95% CI, 2.26-4.40), arrhythmia (aOR, 3.55; 95% CI, 2.53-4.98), pulmonary hypertension (aOR, 3.05; 95% CI, 1.21-7.68), and prescriptions of anticoagulants (aOR, 3.81; 95% CI, 2.57-5.64), positive inotropes (aOR, 2.29; 95% CI, 1.41-3.74), and anti-arrhythmic drugs (aOR, 2.14; 95% CI, 1.10-4.15).
“Cardiopulmonary factors were associated with hospitalization for HF in the 30 days following a COPD exacerbation, while only cardiovascular-related factors and exacerbation severity were associated with AF hospitalization. Understanding factors will help target people for prevention,” the researchers concluded.