Exploring the cardiopulmonary effects of tirzepatide in atrial fibrillation and comorbid chronic obstructive pulmonary disease.

BACKGROUND: The coexistence of atrial fibrillation and chronic obstructive pulmonary disease often leads to worse clinical outcomes. Tirzepatide is a promising therapy for diabetes and weight management, with potential cardiovascular benefits via anti-inflammatory effects. However, its impact in patients with both atrial fibrillation and chronic obstructive pulmonary disease is unknown. METHODS: Using the TriNetX Analytics Research Network, patients aged ≥18 years with atrial fibrillation and chronic obstructive pulmonary disease between 6/1/2022 and 1/1/2024 were included. Patients were divided into tirzepatide and control groups. Propensity score matching included demographics, comorbidities, cardiovascular medications, and left ventricular ejection fraction. Outcomes were all-cause mortality, cardiac events, and chronic obstructive pulmonary disease exacerbation over one year. RESULTS: A total of 3,728 tirzepatide users and 499,199 controls were identified; 3,726 patients remained in each group after matching. Tirzepatide use was associated with lower odds of 1-year all-cause mortality (OR: 0.145; 95% CI: 0.115-0.184), hospitalization (OR: 0.284; 95% CI: 0.258-0.313), stroke (OR: 0.619; 95% CI: 0.519-0.738), cardiac arrest (OR: 0.491; 95% CI: 0.362-0.667), heart failure exacerbation (OR: 0.270; 95% CI: 0.236-0.308), and chronic obstructive pulmonary disease exacerbation (OR: 0.586; 95% CI: 0.513-0.671). Lower odds of anti-arrhythmic drug initiation, cardioversion, and atrial fibrillation ablation were also observed. CONCLUSION: Tirzepatide use was associated with improved mortality and cardiovascular outcomes in patients with atrial fibrillation and chronic obstructive pulmonary disease and reduced need for rhythm control interventions. Prospective studies are needed to validate these findings.