Causes of Death in Anticoagulated Patients With AF

Study Questions:

What are the causes of death in patients receiving direct oral anticoagulants (DOACs) or warfarin therapy for stroke prevention in atrial fibrillation (AF)?

Methods:

The authors performed a systematic review and meta-analysis of randomized trials comparing DOACs versus warfarin. The main outcome was mortality and independently adjudicated specific causes of death.

Results:

From four randomized trials, 71,683 patients were included and 6,206 (9%) died during follow-up. Adjusted mortality rates were 4.72%/year (95% confidence interval [CI], 4.19-5.28%/year). Of the patients who died during follow-up, cardiac death was the cause in 46%, followed by nonhemorrhagic stroke or systemic embolism (5.7%) and hemorrhage-related deaths (5.6%). As compared with patients who remained alive, patients who died during study follow-up more often had a history of heart failure (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.25-2.44), permanent or persistent AF (OR, 1.38; 95% CI, 1.25-1.52), diabetes (OR, 1.37; 95% CI, 1.6-4.8), were more often male (OR, 1.24; 95% CI, 1.13-1.37), were older age (mean difference, 3.2 years; 95% CI, 1.6-4.8), and had a lower creatinine clearance (mean difference, -9.9 ml/min; 95% CI, -11.3 to -8.4).

Conclusions:

The authors concluded that among AF patients treated with oral anticoagulants, most deaths were cardiac-related, while stroke and bleeding-related deaths were rarer.

Perspective:

The authors highlight that among patients receiving OACs for stroke prevention in AF, most patients do not die from complications of their AF (e.g., stroke) or their treatment (e.g., intracranial hemorrhage). Rather, most of these patients die from other cardiac causes. Clinicians caring for AF patients should review all cardiovascular risk factors and prevention strategies with this at-risk population.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Cause of Death, Creatinine, Diabetes Mellitus, Embolism, Heart Failure, Hemorrhage, Intracranial Hemorrhages, Primary Prevention, Risk Factors, Stroke, Warfarin


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