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
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引用次数: 0
Abstract
Purpose: 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.
目的：由于缺乏证据，慢性阻塞性肺疾病（COPD）和心房颤动（AF）共存的治疗仍不清楚。本研究旨在发现-受体阻滞剂和肾素-血管紧张素-醛固酮系统抑制剂（RAASi）在这一特殊人群中的作用。患者和方法：我们设计了一项观察性现实研究，包括来自全国20家医院的2016例房颤患者。慢性阻塞性肺病的诊断从病例报告中提取并由专家确认。研究终点为全因死亡率。采用Kaplan-Meier曲线和Log rank检验分析不同治疗的预后。使用多个多变量Cox回归模型来确定药物的独立预后价值。结果：大约30%的患者开了β受体阻滞剂或RAASi。生存曲线显示-受体阻滞剂不影响AF合并COPD患者的全因死亡率（P=0.130）。RAASi患者预后优于无RAASi患者（P=0.011）。在多变量Cox回归分析调整人口统计学、其他合并症和治疗后，β受体阻滞剂和血管紧张素II受体阻滞剂（ARB）没有独立影响终点。血管紧张素转换酶抑制剂（ACEI）仍然是AF合并COPD患者总生存率的保护因素(模型1:HR=0.45, 95% CI 0.21-0.98， P=0.045；模型2:HR=0.41, 95% CI 0.18-0.93， P=0.034；模型3:HR=0.38, 95% CI 0.16-0.89， P=0.026)。结论：β受体阻滞剂不影响AF和COPD患者的总生存，而ACEI可能具有保护作用。
期刊介绍：
An international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus will be given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self management protocols. This journal is directed at specialists and healthcare professionals
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