15 Percent of COPD Exacerbation Patients Develop Arrhythmias, Tripling In-Hospital Death Risk: Meta-Analysis
China: Cardiac arrhythmias are frequent among patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and are strongly linked to higher short-term mortality, a new systematic review and meta-analysis has reported. The findings suggest that nearly one in six patients admitted with AECOPD develops abnormal heart rhythms, with atrial fibrillation posing the greatest threat to survival.
"Arrhythmias affect around 15% of patients admitted with AECOPD and are linked to a substantially increased risk of short-term mortality, especially in those with atrial fibrillation," the authors wrote.
The analysis was conducted by Nan Ding and colleagues from the Department of Cardiovascular Medicine, The First Affiliated Hospital of Guangzhou Medical University, and published in the International Journal of Chronic Obstructive Pulmonary Disease. The team synthesized data from 28 studies to better understand the prevalence of arrhythmias in this high-risk group and the factors contributing to their occurrence.
From the combined analysis of more than two dozen studies, the researchers observed the following:
- Around 15% of patients hospitalized with acute exacerbations of COPD (AECOPD) developed arrhythmias.
- The presence of arrhythmias was linked to a threefold higher risk of in-hospital mortality (RR 3.33).
- Atrial fibrillation (AF) carried an even greater risk, raising mortality more than threefold (RR 3.70).
- Older age was significantly associated with a higher likelihood of developing arrhythmias.
- Elevated levels of C-reactive protein (CRP), reflecting systemic inflammation, further increased arrhythmia risk.
- The use of long-acting beta-agonists (LABAs) was tied to a lower risk of arrhythmias (OR 0.42).
While this suggests a possible protective effect, the researchers cautioned that the relationship requires careful interpretation and further investigation.
The study highlights the importance of vigilant cardiac monitoring in patients hospitalized with AECOPD. According to the authors, arrhythmias often remain underrecognized in this setting but carry significant implications for patient prognosis. Integrating routine ECG surveillance and adopting individualized risk stratification strategies could help clinicians detect arrhythmias early and intervene promptly.
Despite robust methodology and sensitivity analyses confirming the consistency of findings, the authors acknowledged some limitations. Most of the included studies originated from Europe, North America, and East Asia, with sparse data from regions such as South Asia, Central, and South America. This geographical imbalance could affect the global applicability of the results. Additionally, heterogeneity across studies was considerable, largely due to differences in populations, monitoring methods, and definitions of arrhythmia.
Nonetheless, the meta-analysis adds valuable evidence to the growing recognition of cardiovascular complications in COPD. It highlights the intertwined nature of pulmonary and cardiac health, particularly during acute disease flares. The authors emphasized the need for future prospective studies and standardized definitions of arrhythmia outcomes to refine risk prediction and improve management strategies.
"Aging and systemic inflammation are major drivers of this risk, while LABA therapy may offer some protection. Early detection, continuous monitoring, and personalized treatment approaches are key to improving outcomes for this vulnerable patient population, the authors concluded.
Reference:
Ding N, Qiu W, Chen J, Wang K, Chen Z, Cai R, Chen A. Prevalence and Risk Factors of Arrhythmias in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis. 2025;20:3059-3072. https://doi.org/10.2147/COPD.S545658
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