• Xiaochun Xiao, Hedong Han, Cheng Wu, Qian He, Yiming Ruan, Yinghong Zhai, Yongqing Gao, Xinxin Zhao, and Jia He.
• Department of Health Statistics, Second Military Medical University, Shanghai, China.
• Chest. 2019 May 1; 155 (5): 918-927.

BackgroundThis study aimed to evaluate the prevalence of atrial fibrillation (AF) in hospital encounters with end-stage COPD on home oxygen admitted for COPD exacerbation.MethodsWe used the 2003 to 2014 Nationwide Inpatient Sample to conduct a retrospective analysis. This study included all patients ≥ 18 years of age with a primary diagnosis of COPD on home oxygen who were hospitalized for COPD exacerbation. We used multivariate-adjusted models to evaluate the association of AF with clinical factors, cost, length of stay, and hospital outcomes.ResultsIn total, 1,345,270 patients were included; of these, 244,488 (18.2%) had AF. The AF prevalence increased from 12.9% in 2003 to 21.3% in 2014 (P < .0001) and varied by age, sex, race, income, insurance type, and hospital region. Advancing age, female sex, white race, high income, and large hospital size were associated with increased odds of AF. Presence of AF was a risk predictor for in-hospital death (OR, 1.54; 95% CI, 1.45-1.65), acute respiratory failure (OR, 1.09; 95% CI, 1.06-1.12), invasive mechanical ventilation (OR, 1.37; 95% CI, 1.29-1.47), noninvasive mechanical ventilation (OR, 1.14; 95% CI, 1.09-1.18), acute kidney injury (OR, 1.09; 95% CI, 1.04-1.13), sepsis (OR, 1.23; 95% CI, 1.10-1.37), and stroke (OR, 1.80; 95% CI, 1.40-2.32). AF was also associated with increased cost and length of stay.ConclusionsAF prevalence in hospital encounters with end-stage COPD increased from 2003 to 2014. Better management strategies for patients with end-stage COPD comorbid with AF are needed, especially in elderly individuals.Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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