Bidirectional association between COPD and AF: a systematic review and meta-analysis.

Objective: This study aims to comprehensively evaluate the bidirectional epidemiological association between chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF), as well as their combined impact on prognosis, providing evidence to inform the clinical management of comorbidities. Methods: In accordance with PRISMA guidelines, a systematic literature search was conducted in PubMed, EMBASE, and the Cochrane Library from inception through June 2025, focusing on cohort and case-control studies. Study quality was assessed using the Newcastle-Ottawa Scale, and odds ratios (OR) were pooled using either random-effects or fixed-effects models to quantify the bidirectional risk between COPD and AF and their prognostic effects. Results: A total of 48 unique publications were included. The findings showed that AF was associated with a higher risk of COPD (OR = 1.56, 95% CI 1.06-2.29), and COPD was similarly associated with a higher risk of AF (OR = 1.72, 95% CI 1.42-2.09). Additionally, AF in COPD patients was associated with increased short-term (OR = 1.76) and long-term (OR = 1.27) mortality risks, while COPD in AF patients was also associated with increased mortality risks (short-term OR = 1.54, long-term OR = 1.68). Conclusion: COPD and AF showed a bidirectional observational association, and their coexistence was associated with increased mortality risk. Given the observational nature of the included studies and substantial heterogeneity, these findings should be interpreted as associations rather than causal effects. These findings highlight the need for integrated and individualized management strategies in patients with comorbid COPD and AF. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251069785.