All-Cause Mortality in 272,186 Patients Hospitalized With Incident Atrial Fibrillation 1995-2008: A Swedish Nationwide Long-Term Case-Control Study

Study Questions:

Is atrial fibrillation (AF) associated with a higher risk of death?


The Swedish National Patient Registry and the Cause of Death Registry were queried to identify 272,186 patients (mean age 72.3 years) with AF diagnosed during hospitalization in 1995-2008. Two age- and gender-matched controls were identified for every AF patient. Comorbidities were analyzed and deaths during a mean of 14 years of follow-up were identified through registry data.


After adjustment for age and comorbidities, in individuals under the age of 65 years, AF independently was associated with a 1.76-fold increase in the relative risk of death compared to controls in men, and a 2.15-fold increase in women. In the age group of 65-74 years, AF was associated with a 1.36-fold increase in the relative risk of death in men, and a 1.72-fold increase in women. In the age group of 75-85 years, AF was associated with a 1.24-fold increase in the relative risk of death in men, and a 1.44-fold increase in women. In each age group, the increase in relative risk of death was significantly greater in patients with AF than in controls and in women with AF than in men with AF. Chronic renal failure, neoplasm, and chronic obstructive pulmonary disease contributed the most to the higher risk of mortality.


AF is an independent risk factor for death, particularly in patients under the age of 65 years and in women.


Prior studies have presented conflicting results on the interaction between AF and gender. This study, which had a much larger sample size than prior studies, presents strong evidence that AF has a greater impact on mortality in women than in men.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Stroke, Follow-Up Studies, Disease Management, Risk Factors, Cause of Death, Renal Insufficiency, Case-Control Studies, Cardiology, Heart Failure, Hospitalization, Lung Diseases

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