What is the clinical evidence from this study?

Study design: Observational. Population: Atrial Fibrillation (n=269). Intervention: Antithrombotic treatment vs. No antithrombotic treatment / Antiplatelet treatment. Primary outcome: All-cause mortality (OR 0.344, 95% CI 0.163-0.728, p=0.003).

January 1, 2014Open Access

Atrial Fibrillation and Cardiovascular Comorbidities, Survival and Mortality: A Real-Life Observational Study

Key Result

Antithrombotic treatment significantly reduced the risk of all-cause mortality (OR 0.344) in patients over 60 years old with atrial fibrillation.

Study Design

Type

Observational (n=269)

Multicenter

Yes

Structured PICO

Population

269 adults over 60 years old with a diagnosis of atrial fibrillation, mean age 78.7 years, 49.8% female, based in Spain (Catalonia). 95.6% had a CHA2DS2-VASc score ≥ 2.

Outcome

Overall survival and all-cause mortalityhard clinical

In a real-world cohort of older patients with atrial fibrillation, oral anticoagulation and statin therapy were associated with significantly lower all-cause mortality.

Main Result

Effect estimate: OR 0.344 (95% CI 0.163-0.728)

p-value: p=0.003

Limitations

Retrospective collection of some data
Exclusion of unconfirmed AF cases or changed diagnoses
Observational design cannot prove causality

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia encountered in clinical practice affecting up to 10% of the population over 60 years old and its prevalence rises with age. The main goals were to characterize the AF patient population after the initial diagnosis of AF and to determine overall survival. Methods: It is a real-life observational study of 269 subjects with an AF diagnosis over 60 years old randomly selected. The collected variables were: sociodemographic, cardiovascular complications/comorbidities (CVCs) included in the CHA 2 DS 2 -VASc and HASBLED scores, drug assigned as clinical treatment, mean range INR and CVCs and death dates (all-cause mortality). The survival curve and the risk of death were assessed using Kaplan-Meier survival curve and comparisons with log-rank. Results: The average following time was 6. 2 ± 3. 7 years (0. 2-20. 4). Eleven point five percent died. Sixty-five point four percent had some CVCs. There were no differences in the overall incidence of CVCs by gender. The survival probability was 0. 86 ± DE 0. 03 among men and 0. 90 ± DE 0. 04 among women without differences. Thirty-six point eight percent (95% CI: 30. 8 - 42. 7) were diagnosed vascular complications before AF diagnosis, being ischemic cardiopathy (24. 2%) and ischemic stroke (23. 2%) the most frequent. The mortality is higher (P =3 vascular complications and significantly lower among those treated with statins (P = 0. 032). After AF diagnosis, the most frequent was the cardiac heart failure (46. 7%), significantly higher among women (P = 0. 037). The mortality is significantly lower in those treated with OAC (P = 0. 003). Conclusions: AF is associated with ischemic heart disease, ischemic stroke and congestive heart failure, but the average mortality age is not different from the global population in Spain and Catalonia. Cardiol Res. 2014;5 (1): 12-22 doi: http: //dx. doi. org/ 10. 14740/ cr324e

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