The prevalence of cardiac arrhythjviias and associated risk factors among patients with chronic obstructive pulmonary disease at Kenyatta National Hospital

Abstract

Background Cardiac arrhythmias are common in COPD patients and are a major cause of morbidity and mortality, especially the persistent supraventricular and ventricular rhythm disorders. Multiple factors such as hypoxemia! hypercapnia, acidosis. right heart failure and medication e.g. xanthene derivatives, steroids and β2 agonists have been implicated. Recently P wave dispersion and QTc wave dispersion have been reported to predict the development of atrial fibrillation and ventricular arrhythmias respectively. Objective To determine the prevalence of cardiac arrhythmias among patients with COPD, and describe the associated factors. Study Design Cross-sectional descriptive study done over a period of six months prospectively Setting Outpatient Chest clinic and chest ward, Kenyatta National Hospital. Study Population COPD patients who met the eligibility criteria. Results A total of207 patients with COPD were studied. The male to female ratio was 2.3: I. The mean (SO) age of the study population was 66.7(8.5.) years. The median duration of COPD diagnosis was 1 year (range-0- 6 years) and the median duration of follow-up was also 1 year (range- 0-5 years). Past smokers accounted for 99.8% while only 1% were current smokers.The main occupation sited was agriculture at 72.9%.Most of the patients(97.1%) were on medication with majority (35.7%) on a combination of LAB A, SABA, oral theophylline, and inhaled steroids. A minority (21.6%) used the medications regularly; 'the rest intermittently. The prevalence of arrhythmia was 14% (95%C1 9.3-18.7). The commonest arrhythmia was VPB (51.7%). Atrial fibrillation accounted for 24%. Atrial fib +VPB accounted for 10.3%, while 13.8% had 3° heart block. Majority (96%) of those with arrhythmias were in stage III & IV of COPD. A higher COPD stage, Hypokalemia, hypomagnesaemia, hypoxia, hypercapnia, acidosis, and longer QTc & P-wave dispersion was significantly associated with arrhythmias (p<O.OOI). Conclusion Arrhythmias are common among COPD patients at K.N.H. and a screening 12 lead ECG and regular electrolyte monitoring needs to be incorporated into the basic workup of COPD patients in order to identify potentially correctable rhythm disorders .