[Analysis of risk factors for all cause-mortality in Chinese emergency atrial fibrillation patients].

ABSTRACT

OBJECTIVE: To explore the independent risk factors associated with one-year mortality in patients with atrial fibrillation (AF). METHODS: This study consecutively enrolled AF patients presenting to an emergency department at 20 Chinese hospitals from November 2008 to October 2011. Their baseline data and therapies were recorded. They were followed up for one year. Their major cardiovascular outcomes were recorded. And the predictors of one-year mortality were identified by uni- and multi-variate Cox regression analysis with baseline, therapy variables and follow-up therapy variables. RESULTS: The one-year all-cause mortality was 13.8% among a total of 2016 AF patients. They were divided into mortality group (A, n = 279) and survival group (B, n = 1737). The baseline data of two groups were analyzed. The group A patients were older ((76.1 ± 11.6) vs (67.2 ± 13.1) years, P < 0.01) and had smaller body mass index compared with group B ((23.7 ± 3.6) vs (22.3 ± 3.4) kg/m(2), P < 0.01); the proportion of permanent AF and CHADS2 score ≥ 2 points was higher in the group A (71.8% vs 47.5%, P < 0.01). History of heart failure, previous stroke, left ventricular systolic dysfunction, diabetes, dementia and chronic obstructive pulmonary disease (COPD) were in a higher proportion of group A (51.2% vs 35.1%, 26.3% vs 17.6%, 26.7% vs 17.9%, 21.0% vs 14.6%, 6.0% vs 1.6%, 21.4% vs 10.1%, all P < 0.01). With regards to drug treatment, usage of diuretics, digoxin and other anticoagulants (heparin, etc), the values were greater in group A (50.9% vs 42.2%, 41.3% vs 34.7%, 10.0% vs 5.9%, all P < 0.01). The Kaplan-Meier survival curves showed that the mortality rate increased along with rising CHADS2 score. Multi-variate Cox regression analysis showed that age (HR = 1.053, 95%CI 1.040-1.066), permanent AF (HR = 1.374, 95%CI 1.003-1.883), history of heart failure (HR = 1.385, 95%CI 1.009-1.901), previous stroke (HR = 1.345, 95%CI 1.009-1.795), COPD (HR = 1.379, 95%CI 1.030-1.848), unused angiotensin II receptor blocker (ARB) (HR = 1.955, 95%CI 1.349-2.832), aspirin unused (HR = 1.770, 95%CI 1.375-2.278) and warfarin unused (HR = 3.262, 95%CI1.824-5.834) were independent risk factors for one-year mortality of AF patients. CONCLUSION: Age, history of heart failure, previous stroke, COPD history, ARB unused, aspirin and warfarin unused are independent risk factors for one-year all-cause mortality of AF patients.