Causes of Death and Influencing Factors in Patients With Atrial Fibrillation
Top Cited Papers
- 12 November 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 128 (20), 2192-2201
- https://doi.org/10.1161/circulationaha.112.000491
Abstract
Background—Atrial fibrillation is associated with increased mortality, but the specific causes of death and their predictors have not been described among patients on effective anticoagulant therapy. Methods and Results—The Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial randomized 18 113 patients (age, 71.5±9 years; male, 64%; CHADS2 score, 2.1±1) to receive dabigatran or warfarin. Median follow-up was 2 years, and complete follow-up was achieved in 99.9% of patients. All deaths were categorized by the investigators using prespecified definitions followed by central adjudication. Overall, 1371 deaths occurred (annual mortality rate, 3.84%; 95% confidence interval [CI], 3.64–4.05). Cardiac deaths (sudden cardiac death and progressive heart failure) accounted for 37.4% of all deaths, whereas stroke- and hemorrhage-related deaths represented 9.8% of the total mortality. An examination of the causes of death according to dabigatran or warfarin showed that dabigatran significantly reduced vascular (embolism and hemorrhage-related) mortality (relative risk, 0.63; 95% CI, 0.45–0.88; P=0.007), whereas other causes of death were similar between treatments, including cardiac mortality (relative risk, 0.96; 95% CI, 0.80–1.15; P=0.638). The two strongest independent predictors of cardiac death in this population were heart failure (hazard ratio, 3.02; 95% CI, 2.45–3.73; PPConclusions—The majority of deaths are not related to stroke in a contemporary anticoagulated atrial fibrillation population. These results emphasize the need to identify interventions beyond effective anticoagulation to further reduce mortality in atrial fibrillation. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00262600.This publication has 35 references indexed in Scilit:
- Update on acute coronary syndromes: the pathologists' viewEuropean Heart Journal, 2012
- Representativeness of the dabigatran, apixaban and rivaroxaban clinical trial populations to real-world atrial fibrillation patients in the United Kingdom: a cross-sectional analysis using the General Practice Research DatabaseBMJ Open, 2012
- Incidence and Prevalence of Atrial Fibrillation and Associated Mortality Among Medicare Beneficiaries: 1993–2007Circulation: Cardiovascular Quality and Outcomes, 2012
- Atrial FibrillationCirculation, 2011
- Atrial Fibrillation and Mortality in Heart FailureCirculation: Heart Failure, 2011
- ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)European Heart Journal, 2011
- Risk of Death and Cardiovascular Events in Initially Healthy Women With New-Onset Atrial FibrillationJAMA, 2011
- Mortality Associated With Atrial Fibrillation in Patients With Myocardial InfarctionCirculation, 2011
- Prevention of Atrial FibrillationCirculation, 2009
- Thrombosis and Acute Coronary-Artery Lesions in Sudden Cardiac Ischemic DeathThe New England Journal of Medicine, 1984