Low-dose azithromycin prophylaxis in patients with atrial fibrillation and chronic obstructive pulmonary disease.

Bucci, Tommaso ORCID: 0000-0003-2895-6234, Wat, Dennis, Sibley, Sarah, Wootton, Dan ORCID: 0000-0002-5903-3881, Green, David, Pignatelli, Pasquale, Lip, Gregory YH ORCID: 0000-0002-7566-1626 and Frost, Freddy ORCID: 0000-0002-3902-6502 (2024) Low-dose azithromycin prophylaxis in patients with atrial fibrillation and chronic obstructive pulmonary disease. Internal and emergency medicine, 19 (6). pp. 1615-1623. ISSN 1828-0447, 1970-9366

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Abstract

Low-dose azithromycin prophylaxis is associated with improved outcomes in people suffering frequent exacerbations of chronic obstructive pulmonary disease (COPD), but the use of macrolides in patients with cardiovascular disease has been debated. To investigate the risk of adverse events after COPD exacerbations in patients with atrial fibrillation (AF) treated with azithromycin prophylaxis. Retrospective cohort study within the TriNetX Platform, including AF patients with COPD exacerbations. Risks of primary and secondary outcomes were recorded up to 30 days post-COPD exacerbations and compared between azithromycin users and azithromycin non-users. The primary outcomes were the risks for a composite of (1) cardiovascular (all-cause death, heart failure, ventricular arrhythmias, ischemic stroke, myocardial infarction, and cardiac arrest), and (2) hemorrhagic events (intracranial hemorrhage (ICH), and gastro-intestinal bleeding). Cox-regression analyses compared outcomes between groups after propensity score matching (PSM). After PSM, azithromycin users (n = 2434, 71 ± 10 years, 49% females) were associated with a lower 30-day risk of post-exacerbation cardiovascular (HR 0.67, 95% CI 0.61-0.73) and hemorrhagic composite outcome (HR 0.45, 95% CI 0.32-0.64) compared to azithromycin non-users (n = 2434, 72 ± 11 years, 51% females). The beneficial effect was consistent for each secondary outcomes, except ICH. On sensitivity analyses, the reduced risk of adverse events in azithromycin users was irrespective of smoking status, exacerbation severity, and type of oral anticoagulation. Azithromycin prophylaxis is associated with a lower risk of all-cause death, thrombotic and hemorrhagic events in AF patients with COPD. The possible role of azithromycin prophylaxis as part of the integrated care management of AF patients with COPD needs further study.

Item Type:	Article
Uncontrolled Keywords:	Humans, Pulmonary Disease, Chronic Obstructive, Atrial Fibrillation, Azithromycin, Anti-Bacterial Agents, Antibiotic Prophylaxis, Retrospective Studies, Cohort Studies, Aged, Aged, 80 and over, Middle Aged, Female, Male, Propensity Score
Depositing User:	Symplectic Admin
Date Deposited:	23 Jul 2024 13:36
Last Modified:	24 Jan 2026 04:55
DOI:	10.1007/s11739-024-03653-0
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3183092
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