Causes of death in Japanese patients with atrial fibrillation: The Fushimi Atrial Fibrillation Registry

Yoshimori An, Hisashi Ogawa, Yugo Yamashita, Mitsuru Ishii, Moritake Iguchi, Nobutoyo Masunaga, Masahiro Esato, Hikari Tsuji, Hiromichi Wada, Koji Hasegawa, Mitsuru Abe, Gregory Y H Lip, Masaharu Akao, Fushimi AF Registry Investigators

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57 Citations (Scopus)

Abstract

Aims To investigate the causes of death and the associated clinical factors in patients with atrial fibrillation (AF) in the contemporary clinical practice. Methods and results The Fushimi AF Registry is a community-based prospective survey of AF patients since March 2011 in Fushimi-ku, Kyoto. We investigated causes of death and the clinical indicators of cardiovascular (CV) and non-CV death in 4045 patients with available follow-up data by the end of November 2016. The mean age was 73.6 ± 10.9 years and the mean CHA 2 DS 2 -VASc score was 3.38 ± 1.69. Oral anticoagulants were prescribed in 55% of patients. During a median follow-up of 1105 days, there were 705 all-cause deaths (5.5%/year); 180 CV (26% of total deaths), 381 non-CV (54%), and 144 undetermined causes (20%). The most common causes of CV and non-CV death were heart failure (14.5%), malignancy (23.1%), and infection/sepsis (17.3%), while mortality due to stroke was only 6.5%. Mortality due to infection/sepsis and undetermined causes increased with aging. On multivariate analysis, the strongest indicator of CV death was pre-existing heart failure [hazard ratio (HR) 2.42, 95% confidence interval (CI) 1.66-3.54; P < 0.001] and that of non-CV death was anaemia (HR 2.84, 95% CI 2.22-3.65; P < 0.001). Conclusion In a Japanese community-based AF cohort, CV death was not mainly related to stroke but to heart failure. Non-CV death, mainly malignancy and infection, comprised more than a half of all deaths, which increased substantially in accordance with aging. Clinical factors that were associated with CV and non-CV death were distinct.

Original languageEnglish
JournalEuropean heart journal. Quality of care & clinical outcomes
Volume5
Issue number1
Pages (from-to)35-42
Number of pages8
ISSN2058-1742
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Atrial fibrillation
  • Causes of death
  • Community-based registry
  • Stroke/mortality
  • Cardiovascular Diseases/mortality
  • Japan/epidemiology
  • Age Factors
  • Follow-Up Studies
  • Atrial Fibrillation/mortality
  • Comorbidity
  • Humans
  • Middle Aged
  • Risk Factors
  • Male
  • Cause of Death
  • Heart Failure/mortality
  • Sepsis/mortality
  • Neoplasms/mortality
  • Aged, 80 and over
  • Female
  • Registries
  • Aged
  • Anemia/mortality

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