Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Subsequent Risk of Emergency Department Visits and Hospitalizations for Atrial Fibrillation

Abstract

Background Although emerging evidence has suggested the relationship of chronic obstructive pulmonary disease with atrial fibrillation (AF), little is known about whether acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of repeated AF-related healthcare utilization. Methods This is a self-controlled case series study using the population-based emergency department (ED) and inpatient databases of 5 US states from 2007 through 2012. Among patients with existing AF, we identified patients with an AECOPD hospitalization and at least 1 ED visit or hospitalization for AF during the observation period. We constructed conditional Poisson regression models to compare the rate of AF-related ED visits or hospitalizations during sequential 90-day periods after the AECOPD hospitalization, with pre-AECOPD days 1 to 90 as the reference. Results We analyzed 944 patients who were hospitalized for AECOPD and had an ED visit or hospitalization for AF during a 450-day period. The median age was 77 years, and 41% were men. Compared with the reference period, the rate of AF-related ED visits or hospitalizations significantly increased in the post-AECOPD days 1 to 90 (7.3 versus 14.1 per 100 person-months; rate ratio, 1.93; 95% CI, 1.63-2.29; P<0.001). Then, the rate decreased to the reference level in the post-AECOPD days 91 to 180 (7.5 per 100 person-months; rate ratio, 1.03; 95% CI, 0.85-1.25; P=0.77) and remained at the reference level during post-AECOPD days 181 to 270 (rate ratio, 0.84; 95% CI, 0.68-1.03; P=0.09) and days 271 to 360 (rate ratio, 0.90; 95% CI, 0.73-1.10; P=0.29). These temporal associations persisted with stratification by age, sex, and season. Conclusions Among patients with existing AF, AECOPD was associated with a higher risk of AF-related ED visit or hospitalization in the first 90-day post-AECOPD period.

Keywords: aged; atrial fibrillation; epidemiology; humans; pulmonary disease, chronic obstructive.

Figure 1.

Selection of study samples Visualized presentation of the selection flow of the study samples.

Figure 2.

Rate ratios of atrial fibrillation-related emergency department visits or hospitalizations before and after hospitalization for acute exacerbation of chronic obstructive pulmonary disease in 30-day intervals Shown is the rate ratio (RR) of the composite outcome (ED visit or hospitalization for atrial fibrillation [AF]) and the 95% CI during 450-day period in 30-day intervals. The reference period was the pre-hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) days 61–90, The rate was highest during the 30-day period immediately after the AECOPD hospitalization (RR 3.03; 95% CI 2.27–4.05; P<0.001) followed by the subsequent 30-day period (RR 2.15; 95% CI 1.58–2.91; P<0.001). In the subsequent periods, the RR did not differ significantly from that in the reference period.