Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients
Review found COPD is common in AF (13% prevalence) & associated with higher risk of all-cause death (OR 2.22; 95% CI 1.93–2.55), CV death (1.84; 1.39–2.43), & major bleeding (1.45; 1.17–1.80) There was no sdifference in outcomes with betablocker use vs non-use in these patients.
Source:
European Heart Journal
SPS commentary:
A related editorial notes that the findings in relation to beta blocker (BB) use are complex and difficult to interpret. The observation that BB use vs. non-use did not alter the outcomes in AF patients with COPD might possibly be explained if the BB agents used were different and the doses chosen were lower in the COPD patients than those known to benefit outcomes in patients following myocardial infarction or heart failure.
Alternatively, the non-BB agents used in the AF patients with COPD, whether for ventricular rate control or for management of comorbidities (such as angina, hypertension, or others), might have had benefits similar to those obtained with a BB, and thus offset any benefits that might otherwise have been demonstrable with BB use.
The editorial adds that in older patients, calcium channel blockers are more likely to achieve control of hypertension than are BBs; verapamil can be broncholytic, in contrast to the potential bronchospastic risk of beta-blockade, and thus improve dyspnoea and the autonomic alterations that can accompany it; and verapamil even more so than diltiazem, especially if used in association with an angiotensin-converting enzyme inhibitor, can be as protective as a BB in post-myocardial infarction patients.