Prevalence, Patterns, and Associated Factors of Cardiac Arrhythmias in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study in Nepal

Abstract

Background:  Chronic obstructive pulmonary disease (COPD) patients are at heightened risk for developing cardiac arrhythmias due to shared risk factors, hypoxemia, and the use of certain medications.  Despite this, routine screening for arrhythmias in COPD patients is often neglected in resource-limited settings. Objective: To determine the prevalence and associated factors of cardiac arrhythmias in patients presented with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) at B&C Medical College Teaching Hospital in Eastern Nepal. Methods: This was a cross-sectional analytical study conducted at B&C Medical College Teaching Hospital and Research Center, Birtamode, Jhapa, Eastern Nepal, from February 10 to May 10, 2026. The study population comprises of 196 patients aged 40 years or above presenting with an acute exacerbation of a pre-existing COPD diagnosis. The primary diagnostic tool for arrhythmia detection was a standard resting 12-lead electrocardiogram (ECG) performed at the time of enrollment or at the earliest clinically appropriate moment during the acute admission. All data were entered and analyzed using IBM SPSS Statistics version 25. Results: Arrhythmia was present in 39.3% COPD patients. Gender distribution differed significantly, with a higher proportion of females in the arrhythmia group (39% vs 23.5%, p=0.021). Among current medications, LAMA use was significantly lower in patients with arrhythmia (51.9% vs 68.9%, p=0.017); LABA, ICS and theophylline use showed no significant difference. Quit duration was shorter in the arrhythmia group, though this only approached significance (p=0.057). When arrhythmia subtypes were further analyzed against demographic and clinical variables, no statistically significant associations emerged. Across arrhythmia subtypes, Conclusion: Cardiac arrhythmia was present in 39.3% of patients with acute exacerbation of COPD, with sinus arrhythmia and atrial fibrillation being the most common. Female gender was significantly associated with arrhythmias, while LAMA use was less common. These findings highlight the need for regular cardiovascular assessment and electrocardiographic monitoring for early detection and management of cardiac arrhythmias.