Related Experiment Video
Updated: May 8, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Causes of death and influencing factors in patients with atrial fibrillation: a competing-risk analysis from the
Eloi Marijon1, Jean-Yves Le Heuzey, Stuart Connolly
1Paris Cardiovascular Research Center, Paris, France (E.M.); Paris Descartes University, Paris, France (E.M., J.-Y.L.H.); European Georges Pompidou Hospital, Paris, France (E.M., J.-Y.L.H.); Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (S.C., S.Y., J.P., J.E., E.T., S.Y.); Boehringer Ingelheim Pharma GmbH & Co KG, Clinical Development and Medical Affairs, Ingelheim am Rhein, Germany, and Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany (M.B.); Cardiovascular Research Foundation and Thomas Jefferson Medical College, New York, NY (M.E.); and Uppsala Clinical Research Centre, University Hospital, Uppsala, Sweden (L.W.).
Background:
Atrial fibrillation is associated with increased mortality, but the specific causes of death and their predictors have not been described among patients on effective anticoagulant therapy.
Methods And Results:
The Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial randomized 18 113 patients (age, 71.5 ± 9 years; male, 64%; CHADS2 score, 2.1 ± 1) to receive dabigatran or warfarin. Median follow-up was 2 years, and complete follow-up was achieved in 99.9% of patients. All deaths were categorized by the investigators using prespecified definitions followed by central adjudication. Overall, 1371 deaths occurred (annual mortality rate, 3.84%; 95% confidence interval [CI], 3.64-4.05). Cardiac deaths (sudden cardiac death and progressive heart failure) accounted for 37.4% of all deaths, whereas stroke- and hemorrhage-related deaths represented 9.8% of the total mortality. An examination of the causes of death according to dabigatran or warfarin showed that dabigatran significantly reduced vascular (embolism and hemorrhage-related) mortality (relative risk, 0.63; 95% CI, 0.45-0.88; P=0.007), whereas other causes of death were similar between treatments, including cardiac mortality (relative risk, 0.96; 95% CI, 0.80-1.15; P=0.638). The two strongest independent predictors of cardiac death in this population were heart failure (hazard ratio, 3.02; 95% CI, 2.45-3.73; P<0.0001), and prior myocardial infarction (hazard ratio, 2.05; 95% CI, 1.61-2.62; P<0.0001).
Conclusions:
The majority of deaths are not related to stroke in a contemporary anticoagulated atrial fibrillation population. These results emphasize the need to identify interventions beyond effective anticoagulation to further reduce mortality in atrial fibrillation.
Clinical Trial Registration Url:
http://www.clinicaltrials.gov. Unique identifier: NCT00262600.
Related Concept Videos
01:24Drug Toxicity: Risk factors
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:28Dysrhythmias II: Classification of Tachyarrhythmias
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Venous Thrombosis III: Interprofessional Care
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias