Heart & lung : the journal of critical care · 2026
Holter-detected arrhythmias and early readmission risk in acute exacerbations of COPD.
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Ding Nan, Qiu Weida, Chen Jinmin, Lu Yao, Chen Zeyue, Cai Ruli, Chen Ailan
Аннотация
BACKGROUND: Cardiac arrhythmias are frequent during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and may reflect cardiopulmonary instability. Their independent prognostic value, however, remains uncertain.
OBJECTIVES: This study evaluated the associations of in-hospital Holter-detected arrhythmias with readmission and length of hospital stay (LOS) in patients hospitalized for AECOPD.
METHODS: This single-center retrospective cohort included 544 consecutive AECOPD hospitalizations (April 2022-September 2024) with ≥24 h Holter monitoring. Arrhythmias were categorized as supraventricular, atrial fibrillation/flutter, ventricular, or conduction block/pause. The primary outcome was hospital readmission during the year following discharge, stratified into 0-7-day, 8-30-day, 31-90-day, and 91-365-day readmission categories. Secondary outcomes included 30-day readmission and prolonged hospitalization (≥10 days). Associations were analyzed using multinomial, logistic, and negative binomial regression adjusted for demographic, clinical, and treatment variables.
RESULTS: Arrhythmias occurred in 60.3% of patients, predominantly supraventricular (44.9%) and ventricular (30.9%). Ventricular arrhythmia was independently associated with very early readmission (0-7 days; adjusted OR 10.49, 95% CI 1.55-71.17), whereas AF/AFL was inversely associated with late readmission (91-365 days; adjusted OR 0.10, 95% CI 0.01-0.88). No arrhythmia subtype predicted prolonged LOS. Incorporating Holter findings into multivariable models improved discrimination and clinical utility for early readmission prediction.
CONCLUSIONS: In-hospital arrhythmias are common in AECOPD but have limited overall prognostic impact. In this cohort, arrhythmia subtypes were not associated with prolonged length of stay. Early Holter monitoring may help identify patients at high risk of very early readmission and support pragmatic inpatient risk stratification.
OBJECTIVES: This study evaluated the associations of in-hospital Holter-detected arrhythmias with readmission and length of hospital stay (LOS) in patients hospitalized for AECOPD.
METHODS: This single-center retrospective cohort included 544 consecutive AECOPD hospitalizations (April 2022-September 2024) with ≥24 h Holter monitoring. Arrhythmias were categorized as supraventricular, atrial fibrillation/flutter, ventricular, or conduction block/pause. The primary outcome was hospital readmission during the year following discharge, stratified into 0-7-day, 8-30-day, 31-90-day, and 91-365-day readmission categories. Secondary outcomes included 30-day readmission and prolonged hospitalization (≥10 days). Associations were analyzed using multinomial, logistic, and negative binomial regression adjusted for demographic, clinical, and treatment variables.
RESULTS: Arrhythmias occurred in 60.3% of patients, predominantly supraventricular (44.9%) and ventricular (30.9%). Ventricular arrhythmia was independently associated with very early readmission (0-7 days; adjusted OR 10.49, 95% CI 1.55-71.17), whereas AF/AFL was inversely associated with late readmission (91-365 days; adjusted OR 0.10, 95% CI 0.01-0.88). No arrhythmia subtype predicted prolonged LOS. Incorporating Holter findings into multivariable models improved discrimination and clinical utility for early readmission prediction.
CONCLUSIONS: In-hospital arrhythmias are common in AECOPD but have limited overall prognostic impact. In this cohort, arrhythmia subtypes were not associated with prolonged length of stay. Early Holter monitoring may help identify patients at high risk of very early readmission and support pragmatic inpatient risk stratification.