What does this research mean for the field?

In Asian patients with non-valvular atrial fibrillation, non-cardiovascular causes of death, particularly infection and sepsis, are significantly more prevalent than cardiovascular causes, with ischemic stroke accounting for less than 5% of all deaths. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 1, 2023Open Access

Causes of death of patients with non-valvular atrial fibrillation in Asians

RKRungroj KrittayaphongElectrophysiology TBThanita BoonyapiphatLampang Hospital SASuchart AroonsiriwattanaUdon Thani Hospital

Structured PICO

What are the causes of death in Asian patients with non-valvular atrial fibrillation, and how does oral anticoagulant use affect these outcomes?

Population

3,405 adults (>18 years) with non-valvular atrial fibrillation from 27 centers in Thailand, mean age 67.8 years, 41.8% female. Exclusions: rheumatic valvular disease, mechanical heart valve, ischemic stroke within 3 months, pregnancy, inability to attend follow-up, hematologic disease increasing bleeding risk, transient/reversible AF.

Intervention

Oral anticoagulants (warfarin or DOACs)

Comparator

No oral anticoagulants (or comparing different OAC types/TTR levels)

Outcome

Death and the cause(s) of death (cardiovascular, non-cardiovascular, or undetermined) evaluated by an independent adjudication committeehard clinical

In Asian patients with non-valvular AF, non-cardiovascular deaths (especially infection/sepsis) are more prevalent than cardiovascular deaths, highlighting the need for holistic care beyond stroke prevention.

Abstract

OBJECTIVES: The aim of this study was to determine the causes of death among Asian non-valvular atrial fibrillation (AF) patients who were registered in a nationwide AF registry, and to investigate the differences in the causes of death in AF patients compared between those who were taking and not taking oral anticoagulant (OAC). METHODS: The COhort of antithrombotic use and Optimal INR Level in patients with non-valvular Atrial Fibrillation in Thailand (COOL-AF) study enrolled non-valvular AF patients from 27 centers in Thailand during 2014-2017 to create the COOL-AF Thailand registry. Cause of death was classified as cardiovascular (CV) death, non-CV death, or undetermined cause of death. All events were evaluated and verified by an independent adjudication committee. RESULTS: There was a total of 3,405 patients (mean age: 67.8 years, 41.8% female), and the mean follow-up duration was 31.8±8.7 months. Three hundred and eighty patients (11.2%) died during follow-up. CV death, non-CV death, and undetermined cause accounted for 121 (31.8%), 189 (49.7%), and 70 (18.4%) patients, respectively. Of those with a known cause of death, heart failure (10%), intracranial hemorrhage (ICH; 10%), sudden cardiac death (6.8%), and ischemic stroke (5.8%) were the most often observed causes of death. Concerning non-CV death, infection/sepsis (27.7%), cancer (5.5%), respiratory (5.2%), and major bleeding (4.5%) were the most prevalent causes of death. The use and type of OAC were found to be major determinants of ICH and major bleeding incidence. CONCLUSION: Death due to ischemic stroke was responsible for only 4.7% of all deaths in Asian AF patients. Non-CV death, such as infection/sepsis or malignancy, was more far more prevalent than CV death in Asian AF patients. An improved integrated care approach is needed to reduce the prevalence of non-CV death in Asian AF patients.

Demander à l'IA

Bookmark

View Full Paper