Background New-onset atrial fibrillation (AF) in patients with chronic obstructive pulmonary disease (COPD) is associated with an accelerated decline in lung function, and a significant increase in mortality rate. A deeper understanding of the risk factors for new-onset AF during COPD will provide insights into the relationship between COPD and AF and guide clinical practice. This systematic review and meta-analysis is designed to identify risk factors for new-onset AF in patients with COPD, and to formulate recommendations for preventing AF in COPD patients that will assist clinical decision making. Methods PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies, which reported the results of potential risk factors for new-onset AF in COPD patients. Results Twenty studies involving 8,072,043 participants were included. Fifty factors were examined as potential risk factors for new-onset AF during COPD. Risk factors were grouped according to demographics, comorbid conditions, and COPD- and cardiovascular-related factors. In quantitative analysis, cardiovascular- and demographic-related factors with a greater than 50% increase in the odds of new-onset AF included age (over 65 years and over 75 years), acute care encounter, coronary artery disease, heart failure and congestive heart failure. Only one factor is related to the reduction of odds by more than 33.3%, which is black race (vs white). In qualitative analysis, the comparison of the risk factors was conducted between COPD-associated AF and non-COPD-associated AF. Cardiovascular-related factors for non-COPD-associated AF were also considered as risk factors for new-onset AF during COPD; however, the influence tended to be stronger during COPD. In addition, comorbid factors identified in non-COPD-associated AF were not associated with an increased risk of AF during COPD. Conclusions New-onset AF in COPD has significant demographic characteristics. Older age (over 65 years), males and white race are at higher risk of developing AF. COPD patients with a history of cardiovascular disease should be carefully monitored for new-onset of AF, and appropriate preventive measures should be implemented. Even patients with mild COPD are at high risk of new-onset AF. This study shows that risk factors for new-onset AF during COPD are mainly those associated with the cardiovascular-related event and are not synonymous with comorbid factors for non-COPD-associated AF. The pathogenesis of COPD-associated AF may be predominantly related to the cardiac dysfunction caused by the chronic duration of COPD, which increases the risk of cardiovascular-related factors and further increases the risk of AF during COPD. PROSPERO registration number CRD42019137758.

中文翻译：

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慢性阻塞性肺疾病患者新发房颤的危险因素：系统评价和荟萃分析

背景 慢性阻塞性肺疾病（COPD）患者新发心房颤动（AF）与肺功能加速下降和死亡率显着增加相关。更深入地了解 COPD 期间新发 AF 的危险因素将有助于深入了解 COPD 和 AF 之间的关系并指导临床实践。这项系统评价和荟萃分析旨在确定 COPD 患者新发 AF 的危险因素，并制定 COPD 患者预防 AF 的建议，以协助临床决策。方法检索PubMed、Embase、Web of Science和Cochrane Library数据库中报告COPD患者新发房颤潜在危险因素结果的研究。结果 纳入了 20 项研究，涉及 8,072,043 名参与者。研究了 50 个因素作为 COPD 期间新发 AF 的潜在危险因素。危险因素根据人口统计、合并症以及慢性阻塞性肺病和心血管相关因素进行分组。在定量分析中，新发 AF 发生率增加超过 50% 的心血管和人口相关因素包括年龄（65 岁以上和 75 岁以上）、急症护理、冠状动脉疾病、心力衰竭和充血性心脏病。心脏衰竭。只有一个因素与赔率降低超过 33.3% 有关，那就是黑人种族（与白人相比）。在定性分析中，对 COPD 相关 AF 和非 COPD 相关 AF 的危险因素进行了比较。非 COPD 相关 AF 的心血管相关因素也被认为是 COPD 期间新发 AF 的危险因素；然而，在慢性阻塞性肺病期间，这种影响往往更强。此外，在非 COPD 相关 AF 中发现的共病因素与 COPD 期间 AF 风险增加无关。结论 COPD 中新发 AF 具有显着的人口统计学特征。年龄较大（65 岁以上）、男性和白人患 AF 的风险较高。有心血管疾病史的 COPD 患者应仔细监测新发 AF 的情况，并采取适当的预防措施。即使是轻度慢性阻塞性肺病患者，新发房颤的风险也很高。这项研究表明，COPD 期间新发 AF 的危险因素主要是与心血管相关事件相关的因素，而不是非 COPD 相关 AF 的共病因素。COPD相关AF的发病机制可能主要与COPD长期病程引起的心功能障碍有关，这增加了心血管相关因素的风险，进一步增加了COPD期间发生AF的风险。PROSPERO 注册号 CRD42019137758。