Contemporary survival and anticoagulation of patients with atrial fibrillation: A community based cohort study in China

Abstract

BackgroundsThe understanding of death in patients with atrial fibrillation (AF) in China is limited. This study aimed to assess the contemporary survival of AF patients in China and to explore risk factors for deaths.MethodsThis was a prospective community-based cohort study including 559 AF patients, who were followed-up from July 2015 to December 2020.ResultsDuring 66-month follow-up, there were 200 deaths (56.5% cardiovascular, 40.0% non-cardiovascular, and 3.5% unknown causes) among 559 AF patients with the median age of 76 years. The top three causes of death were heart failure (33.0%), ischemic stroke (17.0%) and cancer (16.5%). Multivariate Cox regression analysis indicated baseline variables positively associated with all-cause death were age (HR: 1.10, 95% CI: 1.08–1.13), AF subtype (HR: 1.37, 95% CI: 1.08–1.73), prior myocardial infarction (HR: 3.40, 95% CI: 1.48–7.78), previous tumor (HR: 2.61, 95% CI: 1.37–4.98), hypoglycemic therapy at baseline (HR: 1.81, 95% CI: 1.13–2.91), but body weight (HR: 0.98, 95% CI: 0.97–1.00) and use of calcium channel blocker (CCB) (HR: 0.62, 95% CI: 0.41–0.95) played a protective role to all-cause death. Of patients who were alive at the end of follow-up, 24.0% were on oral anticoagulants (OAC) alone, 4.5% on dual antithrombotic therapy, 33.1% on antiplatelet agents alone and 38.4% weren't on any antithrombotic medication.ConclusionIschemic stroke still remains one of the leading causes of death and OAC is seriously underused in AF patients in China. Independent risk factors for death are age, AF subtype, previous tumor, prior myocardial infarction, hypoglycemic therapy, low body weight and no CCB use.Clinical Trial Registrationhttp://www.chictr.org.cn/ (ChiCTR-ICR-15007036).

Long-term outcomes of radiofrequency catheter ablation for patients with persistent atrial fibrillation lasting ≥ 3 years

“…In patients with HF with reduced ejection fraction, the prevalence of AF ranges from 36.7% to 44.9%, and in those with HF with preserved ejection fraction, the AF prevalence is between 40% and 50% [14]. Importantly, HF is a major cause of mortality in AF patients, as evidenced by a Chinese community study showing that HF is the leading cause of death in persistent AF patients [15]. A meta-analysis suggests that catheter ablation can improve the prognosis and quality of life of patients with AF combined with HF [4].…”

“…Importantly, HF is a major cause of mortality in AF patients, as evidenced by a Chinese community study showing that HF is the leading cause of death in persistent AF patients [15]. A meta-analysis suggests that catheter ablation can improve the prognosis and quality of life of patients with AF combined with HF [4].…”

Value of baseline characteristics in the risk prediction of atrial fibrillation

“…Previous works have reported that approximately 15% to 31% of paroxysmal AF patients at the early-stage progress to persistent or permanent AF during a time period between 4 and 8 years ( 17 ). Although AF itself poses little threat to life, ischemic stroke caused by AF is one of the main causes of death (17%) in Chinese community patients with AF ( 15 ). To optimize the early management of AF patients and slow down the progression of AF, Chinese guideline ( 16 ) provides suggestions for AF risk prediction by age and this has been demonstrated by many studies that there is a positive association between the incidence of AF and advancing age ( 18 – 22 ).…”

“…Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or current antihypertensive therapy. Diabetes mellitus was defined as a previous diagnosis of diabetes mellitus, treatment with oral hypoglycemic agents or insulin, or having a fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L) or hemoglobin A1c level ≥ 6.5% ( 15 ). Heart disease is defined as a previous diagnosis of heart failure or coronary heart disease.…”