Causes of Death in Elderly Patients With Non-Valvular Atrial Fibrillation　― Results From the ANAFIE Registry ―

Abstract

Background: Previous studies on mortality in atrial fibrillation (AF) included a limited number of elderly patients receiving direct oral anticoagulants (DOACs). This subanalysis of the ANAFIE Registry evaluated 2-year mortality according to causes of death of elderly non-valvular AF (NVAF) patients in the DOAC era. Methods and Results:The ANAFIE Registry was a multicenter prospective observational study. Mean patient age was 81.5 years and 57.3% of patients were male. Of the 32,275 patients completing the study, 2,242 died. The most frequent causes of death were cardiovascular (CV) death (32.4%), followed by infection (17.1%) and malignancy (16.1%). Incidence rates of CV-, malignancy-, and infection-related death were 1.20, 0.60, and 0.63 per 100 person-years, respectively. Patients aged ≥85 years showed increased proportions of non-CV and non-malignancy deaths and a decreased proportion of malignancy deaths compared with patients aged <85 years. The incidence of death due to congestive heart failure/cardiogenic shock, infection, and renal disease was higher in patients aged ≥85 than those aged <85 years. Compared with warfarin, DOACs were associated with a significantly lower risk of death by intracranial hemorrhage, ischemic stroke, and renal disease.Conclusions: This subanalysis described the mortality according to causes of death of Japanese elderly NVAF patients in the DOAC era. Our results imply that a more holistic approach to comorbid conditions and stroke prevention are required in these patients.

Gastrointestinal bleeding in elderly patients with atrial fibrillation: prespecified All Nippon Atrial Fibrillation in the Elderly (ANAFIE) Registry subgroup analysis

“…In the overall ANAFIE Registry population, cardiovascular disease (32.4%), infection (17.1%), and malignancy (16.1%) were the most common causes of death 34 . In the current study, most deaths were due to extracranial bleeding, cancer, or infection.…”

Causes of death in patients with atrial fibrillation with a focus on ischemic stroke mortality: a single-center retrospective study

“…心房細動(AF)は高齢者に多くみられる不整脈で，脳 卒中および心不全発症増加のみならず全死亡，心不全死 および脳卒中死増加と強く関連している 1,2) ． 研究デザイン，研究年代，観察期間，地域 /人種を含 む患者背景，治療内容などの要因が，AF 患者の死亡率 や死因内容に影響を及ぼすことが知られている [3][4][5][6][7][8][9][10][11][12][13] ．最 近の AF 患者の死因別死亡に関する報告をみると，全死 亡に占める割合は異なるものの，心血管疾患死，感染症 死，悪性腫瘍死が上位を占め，脳卒中死が占める割合 は 10% に満たないという見解は共通している [6][7][8][9][10][11][13][14][15] ． 一方，脳卒中死などの死因別死亡率の経時的変動 11,12) や脳卒中(脳梗塞)死に影響を及ぼす因子を検討した報…”

Lead-Specific Performance for Atrial Fibrillation Detection in Convolutional Neural Network Models Using Sinus Rhythm Electrocardiography

“…Atrial fibrillation (AF) is one of the most prevalent cardiac rhythm disorders and is associated with increased morbidity such as ischemic stroke, and mortality. 1 – 3 A significant challenge in managing AF is its timely detection, given that it is asymptomatic nature in many patients. Various screening tools have been proposed as alternatives to the gold standard 12-lead ECG, including patient-initiated devices such as oscillometric blood pressure cuffs, intermittent ECG rhythm strips, or smartphone photoplethysmograms, as well as semi-continuous options such as smartwatch ECGs and continuous wearable devices such as long-term Holter monitors, wearable belts, or 1–2 week continuous ECG patches.…”