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ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN EASTERN AFGHANISTAN
Akmal Shams1, Head of Cardiology and Medicine Department
Hayatullah Ahmadzai2
Ikramullah Ibrahimi2
Salam Jan Shams2
1Afghan Momand Medical Complex
2Nangarhar University
(Afghanistan, Nangarhar)
DOI:10.24412/2500-1000-2024-2-1-60-64
Abstract. Chronic obstructive pulmonary disease is the leading respiratory disease which not only bears complications in the lungs but also in other systems of the body including heart which for example complicates to atrial fibrillation. The aim of the study was to investigate the incidences of atrial fibrillation in patients with chronic obstructive pulmonary disease.
It was a retrospective cross sectional study conducted on the data of two years from patients admitted under the diagnosis of chronic obstructive pulmonary disease in multiple centers in Nangarhar. The study included both male and female patients aging 18 years and over based on purposive sampling.
The study included 296 patients of whom 158 (53.6%) were males and 138 (44.4%) were females. Mean age of the study population was 59.5±11.6 years. 51 out of 296 (17.2%) patients had atrial fibrillation: 26 (16.3%) males and 25 (18.1%) females. There was no case in age group 18-28 years but increasedfurther on such as 3 cases (5.9%) in 29-39 years, 5 (9.8%) cases in 40-49 years, 14 (27.5%) cases in 50-59 years, and 27 (56.8%) cases in age group 60 and over. Atrial fibrillation was more prevalent in smokers 27 (20.3%) compared to non-smokers 14 (14.1%). Mean pulse deficit across atrial fibrillation patients was 23 ± 7 beats per minute.
Atrial fibrillation was more prevalent in patients with chronic obstructive pulmonary disease especially in females, old age, smokers, and physically inactive patients. Awareness programs should be designed to early detect cases and precision should be made in selecting medicine for chronic obstructive lung disease taking atrial fibrillation into consideration.
Keywords: Atrial fibrillation, Arrhythmia, COPD, Chronic bronchitis, Emphysema.
Chronic obstructive pulmonary disease (COPD) is the leading respiratory system disease known for airflow limitation to the lungs. In fact, the American Thoracic society included two diseases in the definition of COPD: Chronic bronchitis known for productive cough and emphysema known for chronic dyspnea due to terminal bronchiole alveolar dilatation and destruction (1). The overall prevalence of COPD is 10% worldwide (2) although criteria for its diagnosis varies. Global initiatives for lung disease (GOLD) defined COPD case by spirometry as the ratio of forced expiratory volume in one second divided by forced vital capacity less than 0.7 (1) though there is physiology variation in the aforementioned ration regarding age as being lower in old ages without disease and normal
despite disease in young people (3). COPD not only bears complications in lungs but also in other parts of the body such as heart which for example causes atrial fibrillation (4). Responsible mechanisms for the development of atrial fibrillation in COPD patients include hypoxemia, hypercapnia, inflammation, aging, increased thoracic pressures (5) and medicines used for COPD such as beta agonists (6), steroids, anticholinergics (7), theophylline (8), and etc. Several scoring systems have been developed to predict prognosis in the comorbid COPD and atrial fibrillation patients including BODE index which stands for body mass index, airway obstruction, dyspnea scores and exercise. Literature has implicated mechanical changes in both right and left sides of the heart in the base of increased
BODE score (9). In fact, every five-millimeter increase in the diameter of left atrium increases atrial fibrillation incidences by 39% (10). In addition, Atrial fibrillation worsens COPD clinic specifically dyspnea and cyanosis.
Despite many researches on the topics, our hospitals still lack data on the incidences of atrial fibrillation in COPD patients so we aimed to conduct this study to find out the incidences of atrial fibrillation in COPD patients.
Methodology
It was a retrospective cross - sectional study conducted on the two years data of COPD patients at multiple centers in Nangarhar, Afghanistan including both male and female patients aging 18 years and over based on purposive sampling. Patients who had other causes of atrial fibrillation such as thyrotoxicosis, valvular heart disease, and etc. were excluded from the study.
Table 1. Demographic information of the stuc y population
Parameters Frequency Percentage
Gender Male 158 53.4%
Female 138 46.6%
Age Groups 18-28 2 1%
29-39 21 7%
40-49 34 11%
50-59 71 25%
> 60 168 57%
Job Jobless 149 50.3%
Shopkeepers 68 23%
Farmers 26 8.8%
Other jobs 53 17.9%
Mean age of the patients was and the rest of the descriptive statistics are shown in table 2. Table 2. Descriptive statistics___
Parameter Mean ± SD Minimum Maximum
Age 59.5 ± 11.6 34 105
Weight 60 ± 13.6 33 95
Systolic BP 120.5 ± 27.3 60 180
Diastolic BP 101.1 ± 12.7 40 135
Heart rate 104.5 ± 15.4 68 154
Oxygen saturation 101.1 ± 12.7 68 96
In fact, only 51 out of 296 (17.2%) COPD patients had atrial fibrillation. The rest of the patients were in sinus rhythm as shown in figure 1.
COPD diagnosis was already made and written in the files based on GOLD criteria.
Data was collected through pre-structured questionnaire from the medical files of the patients after getting formal authorization. Patients' identity was hidden for ethical purpose and medical record numbers were added instead.
Data was analyzed in SPSS (Statistical Program for Social Sciences). Mean ± standard deviation was used for continuous variables after data being check for normality through Kolmogorov-Smirnov test and frequencies and percentages were used for categorical variables.
Results
There were 296 patients with known diagnosis of COPD 158 (53.4%) of whom were males and the rest 138 (46.6%) were females. Table 1 Shows demographics of the study population.
- Медицинские HayKU -
Figure 1. Atrial fibrillation in COPD patients
In addition, atrial fibrillation was more prevalent in females compared to males i.e. 25 (18.1%) versus 26 (16.3%).
Interestingly, atrial fibrillation cases in patients with chronic obstructive pulmonary disease increased with increasing age. In fact,
we did not notice any atrial fibrillation case in the lowest age group, 18-28 years, however, more than half of the cases happened in the age group of 60 years and over as shown in table 3.
Table 3. Atrial fibrillation prevalence across age groups
Age groups (years) Sinus rhythm Atrial fibrillation
18-28 2 (0.8%) 0 (0%)
29-39 18 (7.3%) 3 (5.9%)
40-49 29 (11.8%) 5 (9.8%)
50-59 57 (23.3%) 14 (27.5%)
>=60 139 (56.7%) 29 (56.9%)
Total 245 (100%) 51 (100%)
Furthermore, atrial fibrillation prevalence was more in smokers (current smokers, past smokers or restarters) compared to those who had not ever smoked i.e. 20.3% versus 14.1%.
In addition, we found out atrial fibrillation across the findings of chest plain radiographs (chest X rays); atrial fibrillation was more prevalent in patients having dirty lungs and cardiomegaly respectively i.e. 66.7% and 43.1%.
Mean pulse deficit across atrial fibrillation was 23 ± 7 beats/minute.
Discussion
The major finding of the study revealed that atrial fibrillation was more prevalent in patients with chronic obstructive pulmonary disease (17.2%) being more prevalent in males compared to females. In fact, atrial fibrillation incidences increased with increasing age. It is because patients with advanced age have other risk factors for the develop-
ment and maintenance of atrial fibrillation such as hypertension, atherosclerosis, and etc. Similarly, studies by Arya et al., Manuti et al., and Terzano et al. (11-13) demonstrated atrial fibrillation prevalence 9%, 8%, and 20.2% respectively in patients with chronic obstructive pulmonary disease. However, sample size in the studies by Arya et al. and Manuti et al., was very small, including around fifty patients. And Terzano included patients aging over 40 years. The aforementioned studies have also shown increased atrial fibrillation prevalence in females and in patients with advanced age. In fact, 52% of patients having atrial fibrillation were in the advanced age group in the study by Terzano (13).
More than half of the patients were smokers in our study; the interesting thing about smoking was that all smokers were male patients and we did not notice any female case. It is because females in country traditionally do not smoke or the hide their smoking habit
because of the social values and personal dig- and atrial fibrillation incidences. Second, we nity. However, smoke other than that of the did not have Holter monitor so we may have tobacco such as dusts and smoke from com- missed some atrial fibrillation cases happen-bustion materials have been shown to in- ing at time other than that for electrocardio-crease COPD (14). In fact, smoking itself in- gram. Otherwise, we may have had more than creases the incidence of atrial fibrillation (15). the current cases of atrial fibrillation.
According to x ray findings in patients Conclusion
with comorbid atrial fibrillation and chronic Our study concluded that atrial fibrillation
obstructive pulmonary disease, most patients was more prevalent in patients with chronic had cardiomegaly. In fact, literature has obstructive pulmonary disease especially in shown that every 5-millimeter increase in the females, old age, smokers, and physically in-diameter of left atrium increases atrial fibril- active patients. Awareness programs should lation by 39% (10). be designed to early detect cases and preci-
Despite the great findings of the study, sion should be made in selecting medicine for there were a few limitations that might have chronic obstructive lung disease taking atrial affected the results some way. First, the study fibrillation into consideration. was retrospective and we could not have Acknowledgement
some variables from the patient files; for ex- The authors express their warm gratitude
ample, computed tomographic reports to to all the staff of hospitals in facilitating data know about the extent of lungs involvement collection.
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ФИБРИЛЛЯЦИЯ ПРЕДСЕРДИЙ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ОБ-СТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ В ВОСТОЧНОМ АФГАНИСТАНЕ
Акмаль Шамс1, заведующий кафедрой кардиологии и медицины Хаятулла Ахмадзай2 Икрамулла Ибрагими2 Салам Джан Шамс2
1Афганский медицинский комплекс Моманд 2Нангархарский университет (Афганистан, Нангархар)
Аннотация. Хроническая обструктивная болезнь легких является ведущим респираторным заболеванием, которое вызывает осложнения не только в легких, но и в других системах организма, включая сердце, что, например, приводит к фибрилляции предсердий. Целью исследования было изучение частоты возникновения фибрилляции предсердий у пациентов с хронической обструктивной болезнью легких.
Это было ретроспективное перекрестное исследование, проведенное на основе данных за два года от пациентов, поступивших с диагнозом хронической обструктивной болезни легких в несколько центров в Нангархаре. В исследование были включены пациенты мужского и женского пола в возрасте 18 лет и старше на основе целенаправленной выборки.
В исследование были включены 296 пациентов, из которых 158 (53,6%) были мужчинами и 138 (44,4%) - женщинами. Средний возраст исследуемой популяции составил 59,5±11,6 лет. У 51 из 296 (17,2%) пациентов наблюдалась фибрилляция предсердий: у 26 (16,3%) мужчин и у 25 (18,1%) женщин. В возрастной группе 18-28 лет не было ни одного случая, но в дальнейшем число случаев увеличилось: 3 случая (5,9%) в возрасте 29-39 лет, 5 (9,8%) случаев в возрасте 40-49 лет, 14 (27,5%) случаев в возрасте 50-59 лет и 27 (56,8%) случаев в возрастной группе 60 лет и старше. Фибрилляция предсердий была более распространена у 27 курильщиков (20,3%) по сравнению с 14 некурящими (14,1%). Средний дефицит пульса у пациентов с фибрилляцией предсердий составил 23 ± 7 ударов в минуту.
Фибрилляция предсердий чаще встречалась у пациентов с хронической обструктивной болезнью легких, особенно у женщин, пожилых людей, курильщиков и физически неактивных пациентов. Следует разработать программы повышения осведомленности для раннего выявления случаев, а также обеспечить точность при выборе лекарств от хронической обструктивной болезни легких с учетом фибрилляции предсердий.
Ключевые слова: фибрилляция предсердий, аритмия, ХОБЛ, хронический бронхит, эмфизема.
