Competitive interaction between chronic obstructive pulmonary disease and CHA2DS2-VASc score in predicting incident atrial fibrillation

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, and an emerging risk factor for atrial fibrillation (AF). CHADS₂ and CHA₂DS₂-VASc scores are significantly associated with incident AF independently of other risk factors. The aim of this study was to demonstrate a possible interaction between COPD and CHA₂DS₂-VASc in predicting incident AF.

Methods: This observational prospective cohort study included 4322 Caucasians with cardiovascular risk factors, stratified by CHA2DS2-VASc score (>2 vs <2) and presence/absence of COPD. To detect AF appearance, patients underwent, every 6months, physical examination, standard 12‑lead electrocardiogram and routine laboratory tests.

Results: COPD prevalence was significantly higher in patients with CHA₂DS₂-VASc≥2 vs CHA₂DS₂-VASc<2 category (13.3% vs 10.5%, P=0.009). During the follow-up, 589 cases of AF were documented (3.8 events/100 patients-year). COPD⁺ showed a significantly higher incidence of AF vs COPD^- patients (17.4 vs 8.4 events/100 patients-year, P<0.0001). In Cox regression models both CHA₂DS₂-VASc score (HR=4.70, 95% CI=3.63-6.08) and COPD (HR=2.04, 95% CI=1.69-2.48) significantly predicted the incidence rate of AF; this was also confirmed introducing the two variables into the same Cox model. A significant competitive interaction between CHA₂DS₂-VASc and COPD was found in a Cox model in patients with CHA₂DS₂-VASc<2 (HR=8.45, 95% CI=5.20-13.74) than in those with CHA₂DS₂-VASc≥2.

Conclusions: COPD is an independent and strong predictor of incident AF. The presence of COPD increases the HR for incident AF about five times in patients with CHA₂DS₂VASc score<2, while the coexistence of a CHA₂DS₂Vasc score≥2 minimizes the prognostic significance of COPD.

Keywords: Atrial fibrillation; CHA(2)DS(2)-VASc score; Cardiovascular risk; Chronic obstructive pulmonary disease.