Cause of death in patients with atrial fibrillation admitted to French hospitals in 2012: a nationwide database study

Abstract

ObjectiveMost patients with atrial fibrillation (AF) have risk factors and coexisting conditions that increase their mortality risk. We performed a cause-of-death analysis to identify predictors of mortality in hospitalised patients with AF in France.Methods and resultsIn this retrospective, population-based cross-sectional study, the Programme de médicalisation des systèmes d'information was used to identify 533 044 adults with a diagnosis of AF or atrial flutter hospitalised for any reason in France from January through December 2012. Stepwise multivariable analyses were performed to identify determinants of mortality. The mean age was 78.0±11.4 years, 47.1% were women, and the mean CHA2DS2-VASc score was 4.0±1.8. During hospitalisation, 9.4% (n=50 165) of the patients died, 34% due to a cardiovascular event, most often heart failure (16.6%), stroke/transient ischaemic attack/systemic embolism (9.8%) or vascular or ischaemic disease (4.0%). The strongest predictors of overall death were age ≥75 years (OR 2.57, 95% CI 2.47 to 2.68), renal failure (OR 1.85, 95% CI 1.81 to 1.89), cancer (OR 1.81, 95% CI 1.78 to 1.85) and lung disease (OR 1.58, 95% CI 1.55 to 1.62).ConclusionsCardiovascular events were the most common cause of death, occurring in one-third of patients, in this comprehensive study of hospitalised patients with AF. Despite the high risk of stroke in this population, only 10% died from stroke/transient ischaemic attack/systemic embolism. The strongest predictors of overall death were non-cardiovascular. Physicians should be encouraged to focus on preventable serious and disabling cardiovascular events (such as stroke) as well as on potentially fatal non-cardiovascular comorbidities.

The influence of frailty under direct oral anticoagulant use in patients with atrial fibrillation

“…In our study, 50% of patients were frail and their mean body weight was 52.5 kg, so the incidence rate observed in this study was not surprising. Furthermore, the incidence rate of non-cardiovascular events was also consistent with past reports (eg, cardiac death in 1.1 per 100 person-years, non-cardiac death in 5.7 per 100 person-years17 and 66% of patients dying due to non-cardiovascular events18). Although the median CHA 2 DS 2 -VASc score in the frail group was 5 and the incidence of stroke or other thromboembolic events was expected to be 6.7% per year,12 ischaemic stroke occurred in 6.2% of frail patients.…”

Patients without comorbidities at the time of diagnosis of atrial fibrillation: causes of death during long‐term follow‐up compared to matched controls

“…In a French nationwide database study, 10% of cardiovascular deaths were caused by stroke. 15 Heart failure, as previously reported, was not commonly listed as the cause of death. 9,16 Guidelines have stated that monitoring of heart failure in death certificates requires an etiological cause, because heart failure is not a natural cause of death while it is an important contributing diagnosis.…”

“…Both female and male patients had significantly higher relative risks for cerebral infarction or stroke related mortality than their controls. In a French nationwide database study, 10% of cardiovascular deaths were caused by stroke …”

Non-Pharmacologic Approach to Prevent Embolization in Patients with Atrial Fibrillation in Whom Anticoagulation Is Contraindicated

“…This number was expected to increase to 5.6 million by the year 2050. 5,6 AF was associated with a 1.5 to 1.9-fold mortality risk after adjustment for the preexisting cardiovascular conditions with which AF was related. 3 Several studies have indicated that most common cardiovascular event associated with mortality in AF is heart failure followed by stroke/systemic embolization (3 and 6).…”