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Chronic obstructive pulmonary disease in patients with atrial fibrillation: Insights from the ARISTOTLE trial

Michael T Durheim1, Derek D Cyr2, Renato D Lopes3

  • 1Duke Clinical Research Institute, Durham, NC, USA; Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA.

International Journal of Cardiology
|October 9, 2015
PubMed

Insights

Patients with atrial fibrillation and chronic obstructive pulmonary disease (COPD) face increased mortality risk but not stroke risk. Apixaban

Area of Science:

  • Cardiology
  • Pulmonology
  • Clinical Trials

Background:

  • Comorbid chronic obstructive pulmonary disease (COPD) is linked to adverse outcomes in cardiovascular disease patients.
  • The specific risks of stroke and mortality in atrial fibrillation patients with COPD remain unclear.

Purpose of the Study:

  • To investigate the association between COPD and the risks of stroke, systemic embolism, and mortality in atrial fibrillation patients.
  • To evaluate if the benefits of apixaban over warfarin in preventing stroke are consistent in patients with and without COPD.

Main Methods:

  • Analysis of 18,201 patients from the ARISTOTLE randomized trial comparing apixaban and warfarin.
  • Cox proportional hazards models were used to assess the association between COPD and outcomes, adjusting for relevant risk factors.

Main Results:

  • COPD was present in 10.8% of patients.
  • COPD was not associated with an increased risk of stroke or systemic embolism (adjusted HR 0.85).
  • COPD was independently associated with a higher risk of all-cause mortality (adjusted HR 1.60) and cardiovascular/non-cardiovascular mortality.

Conclusions:

  • In atrial fibrillation patients, COPD independently increases mortality risk but not stroke risk.
  • The efficacy of apixaban in preventing stroke is consistent for patients with or without COPD.
Abstract

Keywords:
AnticoagulationAtrial fibrillationCOPDMortalityStroke

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