COPD May Predict Mortality in Ventricular Tachyarrhythmias, Sudden Cardiac Arrest

In high-risk patients who present with ventricular tachyarrhythmias and sudden cardiac arrest (SCA), chronic obstructive pulmonary disease (COPD) is an independent predictor of all-cause mortality.

A retrospective observational study was conducted to examine the prognostic effect of COPD in these patients, with results published in Respiratory Medicine.

A large retrospective registry included consecutive patients who had ventricular tachycardia, ventricular fibrillation, and SCA on hospital admission between 2002 and 2016 at the First Department of Medicine, University Medical Centre in Mannheim, Germany. Data from patients with COPD were compared with those of patients without COPD through multivariable Cox regression models and propensity-score matching. The primary prognostic end point was long-term all-cause mortality at 2 years. Secondary end points included all-cause mortality at index date, at 30 days, and after discharge; cardiac death at 24 hours; rehospitalization associated with cardiac causes; and the composite end point of cardiac death at 24 hours, recurrences of ventricular tachyarrhythmias, and appropriate implantable cardioverter defibrillator therapy.

Among 2813 unmatched, high-risk patients with ventricular tachyarrhythmias and SCA, COPD was present in 9%, with slightly higher rates of early cardiac death (36% vs 28%, respectively), whereas ventricular fibrillation was significantly more common in individuals without COPD vs those with the disease (39% vs 28%, respectively; P <.05).

Per multivariable Cox regression models, COPD was associated with the primary end point of long-term all-cause mortality (hazard ratio, 1.245; 95% CI, 1.001-1.549), which was also shown after propensity-score matching (58% vs 39%, respectively; hazard ratio, 1.778; 95% CI, 1.312-2.410; log rank P =.001). Moreover, the secondary end points of all-cause mortality at index, at 30 days, and after hospital discharge; cardiac death at 24 hours, as well as the composite end point, were all significantly higher in patients with COPD (P <.05).

The investigators concluded that in high-risk patients with ventricular tachyarrhythmias and SCA, the presence of COPD is linked to higher all-cause mortality, cardiac death at 24 hours, and higher rates of the composite end point. This analysis “reflects a realistic picture of consecutive healthcare supply of high-risk patients presenting with ventricular tachyarrhythmias and SCA.”

Reference

Rusnak J, Behnes M, Schupp T, et al. COPD increases cardiac mortality in patients presenting with ventricular tachyarrhythmias and aborted cardiac arrest. Respir Med. 2018;145:153-160.