title: Chronic obstructive pulmonary disease predicts higher incidence and in hospital mortality for atrial fibrillation. An observational study using hospital discharge data in Spain (2004-2013).
abstract: BACKGROUND
  Our objectives were to describe and compare trends in the incidence of hospitalization for atrial fibrillation (AF) in patients with and without chronic obstructive pulmonary disease (COPD) in Spain during 2004-2013 and to assess the effect of COPD on the in-hospital mortality (IHM) of patients with AF.
  
  
  METHODS
  We performed a retrospective study using the Spanish National Hospital Discharge Database. The study population comprised patients≥40years with a primary diagnosis of AF. We grouped admissions by COPD status. We selected one age- and sex-matched control for each COPD case. The clinical characteristics, CHA2DS2-VASc score, diagnostic and therapeutic procedures, length of hospital stay (LOHS) and in-hospital-mortality (IHM) were analyzed.
  
  
  RESULTS
  We identified 210,605 admissions for AF (17.0% with COPD). Over time, the prevalence of COPD was stable among men and increased significantly among women. The incidence of admissions for AF during the study period was higher in COPD patients than in non-COPD patients (men, 2.36-fold [95%CI, 2.33-2.40] vs. 1.59-fold [95%CI, 1.56-1.61]). Comorbidities, LOHS and IHM were more common in patients with COPD (2.93% vs. 2.23%, p<0.05). Atrial cardioversion, catheter ablation, and pacemaker implantation were significantly more frequent in non-COPD patients. COPD was associated with higher IHM after admission for AF (OR, 1.14; 95%CI, 1.03-1.26).
  
  
  CONCLUSIONS
  COPD is a very frequent comorbidity in patients hospitalized for AF. The incidence of admissions for AF during the study period was twice as high in patients with COPD than in those without. The presence of COPD during hospitalization for AF increases LOHS and IHM.
authors.affiliation: Medicine Department, Instituto de Investigación Cardiovascular, Hospital Clínico San Carlos, Health Science Faculty, Universidad Complutense Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Méndez-Bailón
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Madrid, Spain. Electronic address: ana.lopez@urjc.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Lopez-de-Andrés
authors.affiliation: Department of Respiratory Medicine, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de Miguel-Diez
authors.affiliation: Medicine Department, Hospital Gregorio Marañon, Madrid, Spain.
authors.forename: José Mª
authors.initials: JM
authors.lastname: de Miguel-Yanes
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Madrid, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: Hernández-Barrera
authors.affiliation: Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Muñoz-Rivas
authors.affiliation: Service de Médicine Interne et Cancerlogie, Centre Hospitalier Saint Cyr, France.
authors.forename: Noel
authors.initials: N
authors.lastname: Lorenzo-Villalba
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Madrid, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jiménez-García
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality*; D016208:Databases, Factual / Q000639:trends; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000401:mortality*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology