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

Peder Emil Warming, Rodrigue Garcia, Carl Johann Hansen, Sami Olavi Simons, Christian Torp-Pedersen, Dominik Linz, Jacob Tfelt-Hansen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Article numberqcac059
Pages (from-to)128-134
Number of pages7
JournalEuropean heart journal - Quality of care & clinical outcomes
Issue number2
Early online date7 Sept 2022
Publication statusPublished - 28 Feb 2023


Dive into the research topics of 'Atrial fibrillation and chronic obstructive pulmonary disease: diagnostic sequence and mortality risk'. Together they form a unique fingerprint.

Cite this