BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

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Objective:to identify the structure and clinical features of affective disorders (AD) and efficiency of antidepressants in in-patients with chronic coronary artery disease (ChCAD), living in Tomsk and the Tomsk Region.Materials andмethods.At a heart center, 1,131 patients with ChCAD were examined: in 290 persons (25.6%) AD were revealed, among them 72.1% were men (n= 209) and 27.9% were women (n= 81). Mean age of women was (63.5 ± 9.4) years and in men (57.9 ± 7.2) years (р= 0.004). AD structure, main syndromes, severity of depression and anxiety according to data of self-questionnaires and clinical scales before and after antidepressant therapy (predominantly with selective serotonin reuptake inhibitors (SSRI)) were studied. Comparative analysis of clinical indices of CAD respective from AD, presence of antidepressant therapy and its efficiency was performed.Results.Chronic AD were found in 45% of patients. Newly diagnosed depressive episodes made up 24.5% and recurrent depressive disorder (RDD) was 24%. 6.5% were bipolar affective disorders (BAD), predominantly bipolar II disorders. Depressive syndrome in 91.7% of patients had the second significant component (more frequently 54.8%). Characteristic of the clinical picture was dominance of complaints of bodily discomfort and pain, anergy and anhedonia. Moderate mental disturbances made up 49.0% (CGI). AD manifested at the age of 48 (40–55) years and preceded development of ChCAD. Natural course of AD was observed in 52.4% of cases. 47.6% (138/290) of patients received antidepressants, and only in 42% (58/138) clinically significant improvement was noted (more than 50% according to CGI). It was difficult to encourage patient adherence to long-term therapy (30–50% according to CGI). Physical activity tolerance (PAT) according to data of veloergometry increased in responders. Psychopharmaco- and psychotherapy should be included into rehabilitative programs for patients with ChCAD and AD.

Objective: to study clinical-biological features of affective disorders including their comorbidity with coronary artery disease and personality disorders and efficacy of psychopharmacotherapy in these patients.Material and Methods. In the first group at a heart station 290 patients with chronic coronary artery disease and affective disorders (209 men and 81 women) were fully examined. The second group included 120 patients (40 men and 80 women) of a psychiatric hospital with affective disorder comorbid with personality disorders. The third group included the study of 29 patients with depressive disorders and a control group (n=21).Results. Data on significant clinical-dynamic, biological and therapeutic features of affective disorders comorbid with coronary artery disease were obtained. It was revealed that presence of a comorbid personality disorder in the case of affective disorders causes the necessity to use a combined psychopharmacotherapy more frequently, worsens indicators of the efficacy of the psychopharmacotherapy of current episode of depression, and increases negative estimation of their social adaptation by these patients. Dysregulation of the processes of programmed cell death in patients with depressive disorders was found.Conclusion. Obtained data testified to the high degree of comorbidity of affective disorders with coronary artery disease and personality disorders which worsened the prediction of the course and indicators of the efficacy of psychopharmacotherapy of these disorders. In patients with depressive disorders the specific weight of mononuclears of peripheral blood was increased in the state of apoptosis.

The contribution of comorbid with coronary artery disease (CAD) mood disorders (MD) into total mortality is contradictory.ObjectiveTo study frequency and time until death due to general causes in groups of patients with comorbid MD, and without them as well as interrelationship of these indicators with comorbid MD and therapy with antidepressants.MethodsInpatients with chronic CAD (n = 333) under conservative therapy were investigated (31% females (n = 103), 69% males (n = 230), mean age 61.8 ± 9.8 years). Team of cardiologists and psychiatrists followed up patients for 7 years (2008–2014). Survival frequency was evaluated by method of life tables.ResultsAmong patients under conservative therapy of CAD the death frequency due to general causes did not differ significantly in presence (n = 80) and absence of MD (n = 253) and was 18.8% and 16.6%, respectively. Correlation of deaths with hypomanic and mixed episodes was revealed (rs = 0.3). The groups differed according to function of immediate risks: patients with MD were at high risk of death during the year after detection of affective symptoms, and in group without MD it increased over the time of observation (Р = 0.0000).Duration of antidepressant therapy was 5.5 ± 0.5 months. Among patients receiving antidepressants (n = 20), during therapy and after one month after discontinuation there were not deaths. Difference of function of immediate risks in these subgroups was not significant (Р = 0.09).ConclusionsPatients with affective disorders and chronic CAD under conservative therapy are at high risk of death within affective episode and therapy with antidepressants did not influence change of risk of death.Disclosure of interestThe authors have not supplied their declaration of competing interest.