J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 17, Number 6, June 2025, pages 309-319

Impact of Chronic Obstructive Pulmonary Disease Burden on Patients With Atrial Fibrillation: A Nationwide Study

Figure 1. Readmission probability of atrial fibrillation patients based on the status of COPD presence or not. COPD: chronic obstructive pulmonary disease.

Figure 2. Survival probability of atrial fibrillation patients based on COPD presence. COPD: chronic obstructive pulmonary disease.

Figure 3. Study results comparing atrial fibrillation in the presence or absence of COPD, analyzing different factors. COPD: chronic obstructive pulmonary disease.

**Table 1.** Baseline Characteristics
Variable	Patients with atrial fibrillation	P-value
COPD: chronic obstructive pulmonary disease; SD: standard deviation; SE: standard error; M: mean.
Indexed admissions, n	873,070	191,912
Demographics
Mean age, years (SD)	70.82 (13.90)	73.19 (10.44)	< 0.001
Female, % (SE)	52.94 (0.09)	52.73 (0.18)	0.247
Insurance carrier, % (SE)
Medicare	70.13 (0.15)	82.30 (0.18)	< 0.001
Medicaid	5.75 (0.07)	6.57 (0.11)
Private insurance	21.52 (0.13)	9.57 (0.14)
Self-pay	2.60 (0.04)	1.55 (0.05)
Median household income percentile, % (SE)
0-25th	26.64 (0.36)	33.47 (0.45)	< 0.001
26-50th	27.77 (0.29)	29.99 (0.33)
51-75th	25.55 (0.27)	22.76 (0.31)
76-100th	20.03 (0.38)	13.78 (0.30)
Hospital characteristics
Bed size, % (SE)
Small	18.94 (0.34)	19.34 (0.39)	0.064
Medium	29.66 (0.40)	29.95 (0.44)
Large	51.40 (0.47)	50.71 (0.51)
Urban-rural designation, % (SE)
Large metropolitan	51.83 (0.60)	46.21 (0.64)	< 0.001
Small metropolitan	37.15 (0.58)	39.60 (0.63)
Micropolitan	8.44 (0.21)	10.97 (0.30)
Non-urban	2.59 (0.09)	3.22 (0.13)
Teaching status, % (SE)
Metropolitan non-teaching	25.77 (0.36)	27.18 (0.40)	< 0.001
Metropolitan teaching	63.20 (0.42)	58.63 (0.48)
Non-metropolitan nonteaching	11.03 (0.23)	14.19 (0.32)
Patient location: NCHS code, % (SE)
Central counties	21.85 (0.50)	18.78 (0.51)	< 0.001
Fringe counties	27.81 (0.56)	25.13 (0.55)
Medium metro counties	22.33 (0.52)	22.56 (0.56)
Small metro counties	10.28 (0.32)	11.53 (0.40)
Micropolitan counties	9.95 (0.18)	12.38 (0.26)
Noncore counties	7.77 (0.17)	9.63 (0.23)
Type of admission, % (SE)
Weekday	77.23 (0.08)	77.33 (0.14)	0.557
Weekend	22.77 (0.08)	22.67 (0.14)
Length of stay, M (SE)	3.26 (0.01)	4.27 (0.02)	< 0.001
Total cost, M (SE)	8,278 (52.39)	10,155 (59.12)	< 0.001
Comorbidities, % (SE)
Cardiac arrhythmias	77.89 (0.17)	75.53 (0.20)	< 0.001
Renal failure	82.13 (0.10)	75.49 (0.17)	< 0.001
Diabetes	73.38 (0.10)	67.12 (0.18)	< 0.001
Do not resuscitate order	92.54 (0.09)	89.70 (0.14)	< 0.001
Elixhauser score, M ± SD	3.43 ± 1.92	5.13 ± 1.93	< 0.001
Primary outcome
Readmission rate, n (M)	79,837 (0.09)	29,424 (0.16)	< 0.001
Death during hospitalization, n (M)	7,481 (0.01)	3,270 (0.02)	< 0.001

Table 1. Baseline Characteristics

Variable

Patients with atrial fibrillation

P-value

No COPD

COPD

COPD: chronic obstructive pulmonary disease; SD: standard deviation; SE: standard error; M: mean.

Indexed admissions, n

873,070

191,912

Demographics

Mean age, years (SD)

70.82 (13.90)

73.19 (10.44)

< 0.001

Female, % (SE)

52.94 (0.09)

52.73 (0.18)

0.247

Insurance carrier, % (SE)

Medicare

70.13 (0.15)

82.30 (0.18)

< 0.001

Medicaid

5.75 (0.07)

6.57 (0.11)

Private insurance

21.52 (0.13)

9.57 (0.14)

Self-pay

2.60 (0.04)

1.55 (0.05)

Median household income percentile, % (SE)

0-25th

26.64 (0.36)

33.47 (0.45)

< 0.001

26-50th

27.77 (0.29)

29.99 (0.33)

51-75th

25.55 (0.27)

22.76 (0.31)

76-100th

20.03 (0.38)

13.78 (0.30)

Hospital characteristics

Bed size, % (SE)

Small

18.94 (0.34)

19.34 (0.39)

0.064

Medium

29.66 (0.40)

29.95 (0.44)

Large

51.40 (0.47)

50.71 (0.51)

Urban-rural designation, % (SE)

Large metropolitan

51.83 (0.60)

46.21 (0.64)

< 0.001

Small metropolitan

37.15 (0.58)

39.60 (0.63)

Micropolitan

8.44 (0.21)

10.97 (0.30)

Non-urban

2.59 (0.09)

3.22 (0.13)

Teaching status, % (SE)

Metropolitan non-teaching

25.77 (0.36)

27.18 (0.40)

< 0.001

Metropolitan teaching

63.20 (0.42)

58.63 (0.48)

Non-metropolitan nonteaching

11.03 (0.23)

14.19 (0.32)

Patient location: NCHS code, % (SE)

Central counties

21.85 (0.50)

18.78 (0.51)

< 0.001

Fringe counties

27.81 (0.56)

25.13 (0.55)

Medium metro counties

22.33 (0.52)

22.56 (0.56)

Small metro counties

10.28 (0.32)

11.53 (0.40)

Micropolitan counties

9.95 (0.18)

12.38 (0.26)

Noncore counties

7.77 (0.17)

9.63 (0.23)

Type of admission, % (SE)

Weekday

77.23 (0.08)

77.33 (0.14)

0.557

Weekend

22.77 (0.08)

22.67 (0.14)

Length of stay, M (SE)

3.26 (0.01)

4.27 (0.02)

< 0.001

Total cost, M (SE)

8,278 (52.39)

10,155 (59.12)

< 0.001

Comorbidities, % (SE)

Cardiac arrhythmias

77.89 (0.17)

75.53 (0.20)

< 0.001

Renal failure

82.13 (0.10)

75.49 (0.17)

< 0.001

Diabetes

73.38 (0.10)

67.12 (0.18)

< 0.001

Do not resuscitate order

92.54 (0.09)

89.70 (0.14)

< 0.001

Elixhauser score, M ± SD

3.43 ± 1.92

5.13 ± 1.93

< 0.001

Primary outcome

Readmission rate, n (M)

79,837 (0.09)

29,424 (0.16)

< 0.001

Death during hospitalization, n (M)

7,481 (0.01)

3,270 (0.02)

< 0.001

**Table 2.** Top 10 Causes of Atrial Fibrillation Readmission
Patient count (numbers)	ICD-10_I10_dx1	Corresponding diagnosis
Patient counts refer to the total number of patients for the entire study year period. COPD: chronic obstructive pulmonary disease.
Overall (the whole study population)
1. 19543.7	I480	Paroxysmal atrial fibrillation
2. 11207.64	I4891	Unspecified atrial fibrillation
3. 9428.531	I110	Hypertensive heart disease with heart failure
4. 8722.494	I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease
5. 8129.352	A419	Sepsis, unspecified organism
6. 5084.327	I481	Persistent atrial fibrillation
7. 3034.057	I482	Chronic atrial fibrillation
8. 2938.654	N179	Acute kidney failure, unspecified
9. 2719.275	J441	Chronic obstructive pulmonary disease with (acute) exacerbation
10. 2683.224	J189	Pneumonia, unspecified organism
If there was no COPD
1. 16092.11	I480	Paroxysmal atrial fibrillation
2. 9333.146	I4891	Unspecified atrial fibrillation
3. 6433.381	I110	Hypertensive heart disease with heart failure
4. 5854.354	I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease
5. 5435.661	A419	Sepsis, unspecified organism
6. 4199.293	I481	Persistent atrial fibrillation
7. 2308.78	N179	Acute kidney failure, unspecified
8. 2240.723	I482	Chronic atrial fibrillation
9. 2104.674	I495	Sick sinus syndrome
10. 1790.016	I4892	Unspecified atrial flutter
If there was COPD
1. 3434.711	I480	Paroxysmal atrial fibrillation
2. 3013.305	I110	Hypertensive heart disease with heart failure
3. 2868.155	I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease
4. 2717.511	J441	Chronic obstructive pulmonary disease with (acute) exacerbation
5. 2702.957	A419	Sepsis, unspecified organism
6. 1914.565	I4891	Unspecified atrial fibrillation
7. 957.3796	J189	Pneumonia, unspecified organism
8. 900.3476	I481	Persistent atrial fibrillation
9. 837.307	J9621	Acute and chronic respiratory failure with hypoxia
10. 813.2898	I5033	Acute on chronic diastolic (congestive) heart failure

Table 2. Top 10 Causes of Atrial Fibrillation Readmission

Patient count (numbers)

ICD-10_I10_dx1

Corresponding diagnosis

Patient counts refer to the total number of patients for the entire study year period. COPD: chronic obstructive pulmonary disease.

Overall (the whole study population)

1. 19543.7

I480

Paroxysmal atrial fibrillation

2. 11207.64

I4891

Unspecified atrial fibrillation

3. 9428.531

I110

Hypertensive heart disease with heart failure

4. 8722.494

I130

Hypertensive heart and chronic kidney disease with heart failure and stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease

5. 8129.352

A419

Sepsis, unspecified organism

6. 5084.327

I481

Persistent atrial fibrillation

7. 3034.057

I482

Chronic atrial fibrillation

8. 2938.654

N179

Acute kidney failure, unspecified

9. 2719.275

J441

Chronic obstructive pulmonary disease with (acute) exacerbation

10. 2683.224

J189

Pneumonia, unspecified organism

If there was no COPD

1. 16092.11

I480

Paroxysmal atrial fibrillation

2. 9333.146

I4891

Unspecified atrial fibrillation

3. 6433.381

I110

Hypertensive heart disease with heart failure

4. 5854.354

I130

Hypertensive heart and chronic kidney disease with heart failure and stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease

5. 5435.661

A419

Sepsis, unspecified organism

6. 4199.293

I481

Persistent atrial fibrillation

7. 2308.78

N179

Acute kidney failure, unspecified

8. 2240.723

I482

Chronic atrial fibrillation

9. 2104.674

I495

Sick sinus syndrome

10. 1790.016

I4892

Unspecified atrial flutter

If there was COPD

1. 3434.711

I480

Paroxysmal atrial fibrillation

2. 3013.305

I110

Hypertensive heart disease with heart failure

3. 2868.155

I130

Hypertensive heart and chronic kidney disease with heart failure and stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease

4. 2717.511

J441

Chronic obstructive pulmonary disease with (acute) exacerbation

5. 2702.957

A419

Sepsis, unspecified organism

6. 1914.565

I4891

Unspecified atrial fibrillation

7. 957.3796

J189

Pneumonia, unspecified organism

8. 900.3476

I481

Persistent atrial fibrillation

9. 837.307

J9621

Acute and chronic respiratory failure with hypoxia

10. 813.2898

I5033

Acute on chronic diastolic (congestive) heart failure

**Table 3.** Predictors of Readmission and Mortality
Predictors	Multivariate estimates
COPD: chronic obstructive pulmonary disease.
Readmission
COPD	1.35	1.32	1.39	< 0.001
Age at admission	1.01	1.01	1.01	< 0.001
Indicator of sex	1.05	1.02	1.07	< 0.001
Medicare vs. Medicaid	1.28	1.23	1.33	< 0.001
Medicare vs. private insurance	0.71	0.68	0.73	< 0.001
Medicare vs. self-pay	0.91	0.84	0.98	0.016
0-25th vs. 26-50th percentile income	0.92	0.90	0.95	< 0.001
0-25th vs. 51-75th percentile income	0.85	0.83	0.88	< 0.001
0-25th vs. 76-100th percentile income	0.83	0.80	0.86	< 0.001
Metro nonteaching vs. metro teaching	0.97	0.95	0.99	0.016
Central vs. small metro counties	0.93	0.87	0.98	0.007
Central vs. micropolitan counties	0.87	0.82	0.92	< 0.001
Central vs. noncore counties	0.82	0.77	0.87	< 0.001
Cardiac arrhythmias	0.86	0.84	0.88	< 0.001
Renal failure	1.18	1.15	1.21	< 0.001
Do not resuscitate order	0.94	0.90	0.97	0.001
Elixhauser comorbidity summary	1.15	1.15	1.16	< 0.001
Mortality
COPD	1.03	0.96	1.11	0.411
Age at admission	1.02	1.01	1.02	< 0.001
Elixhauser comorbidity summary	1.39	1.37	1.42	< 0.001
Indicator of sex	0.72	0.68	0.77	< 0.001
Medicare vs. private insurance	0.76	0.66	0.87	< 0.001
0-25th vs. 26-50th percentile income	0.84	0.77	0.91	< 0.001
0-25th vs. 51-75th percentile income	0.78	0.71	0.85	< 0.001
0-25th vs. 76-100th percentile income	0.70	0.64	0.78	< 0.001
Small vs. large bed size hospital	1.14	1.04	1.25	0.007
Large metro vs. non-metro hospital	1.45	1.10	1.92	0.009
Cardiac arrhythmias	0.87	0.81	0.93	< 0.001
Diabetes	0.70	0.65	0.75	< 0.001
Do not resuscitate order	11.50	10.65	12.42	< 0.001

Table 3. Predictors of Readmission and Mortality

Predictors

Multivariate estimates

Odds ratio

95% confidence interval

P-value

COPD: chronic obstructive pulmonary disease.

Readmission

COPD

1.35

1.32

1.39

< 0.001

Age at admission

1.01

< 0.001

Indicator of sex

1.05

1.02

1.07

< 0.001

Medicare vs. Medicaid

1.28

1.23

1.33

< 0.001

Medicare vs. private insurance

0.71

0.68

0.73

< 0.001

Medicare vs. self-pay

0.91

0.84

0.98

0.016

0-25th vs. 26-50th percentile income

0.92

0.90

0.95

< 0.001

0-25th vs. 51-75th percentile income

0.85

0.83

0.88

< 0.001

0-25th vs. 76-100th percentile income

0.83

0.80

0.86

< 0.001

Metro nonteaching vs. metro teaching

0.97

0.95

0.99

0.016

Central vs. small metro counties

0.93

0.87

0.98

0.007

Central vs. micropolitan counties

0.87

0.82

0.92

< 0.001

Central vs. noncore counties

0.82

0.77

0.87

< 0.001

Cardiac arrhythmias

0.86

0.84

0.88

< 0.001

Renal failure

1.18

1.15

1.21

< 0.001

Do not resuscitate order

0.94

0.90

0.97

0.001

Elixhauser comorbidity summary

1.15

1.16

< 0.001

Mortality

COPD

1.03

0.96

1.11

0.411

Age at admission

1.02

1.01

1.02

< 0.001

Elixhauser comorbidity summary

1.39

1.37

1.42

< 0.001

Indicator of sex

0.72

0.68

0.77

< 0.001

Medicare vs. private insurance

0.76

0.66

0.87

< 0.001

0-25th vs. 26-50th percentile income

0.84

0.77

0.91

< 0.001

0-25th vs. 51-75th percentile income

0.78

0.71

0.85

< 0.001

0-25th vs. 76-100th percentile income

0.70

0.64

0.78

< 0.001

Small vs. large bed size hospital

1.14

1.04

1.25

0.007

Large metro vs. non-metro hospital

1.45

1.10

1.92

0.009

Cardiac arrhythmias

0.87

0.81

0.93

< 0.001

Diabetes

0.70

0.65

0.75

< 0.001

Do not resuscitate order

11.50

10.65

12.42

< 0.001