The Impact of Beta-Blockers and Renin-Angiotensin-Aldosterone System Inhibitors on the Prognosis of Atrial Fibrillation Patients with Chronic Obstructive Pulmonary Disease: A Nation-Wide Registry Study

Hanyang Liang, Jiangshan Tan, Wei Xu, Siqi Lyu, Shuang Wu, Juan Wang, Xinghui Shao, Han Zhang, Yanmin Yang Department of Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of ChinaCorrespondence: Yanmin Yang, Department of Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China, Email [email protected]: The management of the coexistence of chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) remains unclear due to a lack of evidence. This study aimed to find the effect of beta-blockers and renin-angiotensin-aldosterone system inhibitors (RAASi) in this special population.Patients and Methods: We designed an observational real-world study that included 2016 AF patients from 20 hospitals across the country. The diagnosis of COPD was extracted from case report forms and confirmed by specialists. The study endpoint was all-cause mortality. Kaplan-Meier curves and Log rank test were used to analyse the prognosis of different treatments. Several multivariable Cox regression models were performed to identify the independent prognostic value of the medications.Results: Approximately 30% of patients were prescribed beta-blockers or RAASi. Survival curves showed that beta-blockers did not affect all-cause mortality in AF patients with COPD (P=0.130). Patients with RAASi had a better prognosis than those without (P=0.011). After multivariable Cox regression analysis adjusting for demographics, other comorbidities and treatments, beta-blockers and angiotensin II receptor blockers (ARB) did not independently affect the endpoint. Angiotensin converting enzyme inhibitors (ACEI) remained a protective factor for overall survival in AF patients with COPD (model 1: HR=0.45, 95% CI 0.21– 0.98, P=0.045; model 2: HR=0.41, 95% CI 0.18– 0.93, P=0.034; model 3: HR=0.38, 95% CI 0.16– 0.89, P=0.026).Conclusion: Beta-blockers did not affect overall survival in patients with AF and COPD, whereas ACEI may be protective.Keywords: atrial fibrillation, chronic obstructive pulmonary disease, beta-blockers, renin-angiotensin-aldosterone system