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

Circ J. 2023 Jun 23;87(7):957-963. doi: 10.1253/circj.CJ-22-0614. Epub 2023 Jan 17.

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.

Keywords: Cause of death; Elderly; Japan; Non-valvular atrial fibrillation; Real-world study.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Administration, Oral
  • Aged
  • Anticoagulants / adverse effects
  • Atrial Fibrillation* / epidemiology
  • Cause of Death
  • Female
  • Humans
  • Male
  • Prospective Studies
  • Registries
  • Risk Factors
  • Stroke* / etiology
  • Treatment Outcome

Substances

  • Anticoagulants