Factors influencing mortality in atrial fibrillation. Post hoc analysis of an observational study in outpatients.

BACKGROUND: Whether patients with atrial fibrillation (AF) have an increased mortality compared with the general population is controversially assessed. METHODS: The mortality of 409 outpatients with AF (36% female, mean age 62 years, 39% paroxysmal AF, 27% lone AF), who were included in a prospective observational study, was compared with the mortality of the general population. RESULTS: The mortality was 4%/year and constant during the 10 years of follow-up. Age (p<0.0001), heart failure (p=0.0013) and echocardiographically detected reduced left ventricular systolic function (p=0.0353) were independent predictors. The mortality of AF patients was 1.4-fold higher than in the general population, of female 1.5 and of male 1.3. Patients with permanent AF had a 1.5-fold higher and patients with heart failure a 1.7-fold higher mortality than the general population. Patients with lone AF did not differ in the mortality from the general population. The mortality of AF patients was not influenced by the duration of atrial fibrillation. CONCLUSION: The prognosis of AF patients is dependent on the cardiovascular co-morbidity, especially the presence or absence of heart failure.

Mortality and rate of stroke or embolism in atrial fibrillation during long-term follow-up in the embolism in left atrial thrombi (ELAT) study.

BACKGROUND: Patients with atrial fibrillation (AF) have a higher mortality and risk of stroke/embolism than patients with sinus rhythm. HYPOTHESIS: The aim of the study was to assess the association of clinical and echocardiographic characteristics with mortality and stroke/embolism and the use of antithrombotic medication in the year 2000 in patients who participated 1990-1995 in the Embolism in Left Atrial Thrombi (ELAT) study. METHODS: The study included 409 outpatients with nonrheumatic AF (62 +/- 12 years, 36% women, 39% intermittent AF). Patients with thrombi received anticoagulation, patients without thrombi aspirin until follow-up in 1995; thereafter, anticoagulation according to clinical risk factors was recommended. Primary events were death and secondary events were stroke/embolism. All patients were contacted during the year 2000. RESULTS: Mean follow-up was 102 months. Mortality was 4%/year; the cause of death was cardiac (n = 84), fatal stroke (n = 26), malignancy (n = 23), sepsis (n = 5), and unknown (n = 24). Multivariate analysis identified age (p < 0.0001), heart failure (p = 0.0013), and reduced left ventricular systolic function (p = 0.0353) as predictors of mortality. Stroke/embolism occurred in 83 patients, with a rate of 3%/year. Multivariate analysis identified age (p = 0.0006) and previous stroke (p = 0.0454) as predictors of stroke/embolism. In the year 2000, 51 (21%) of the 247 surviving patients received no antithrombotic medication, 88 received (36%) oral anticoagulants, 102 (41%) acetylsalicylic acid, and 6 (2%) low-molecular heparin. CONCLUSIONS: Therapy for heart failure and oral anticoagulation in AF should be seriously considered, especially in elderly patients and in those with previous stroke.