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Mortality and cause of death in patients with chronic non-rheumatic atrial fibrillation after a two-year follow-up.
G Ital Cardiol. 1999 Jun; 29(6):637-46.GI

Abstract

BACKGROUND

Non-rheumatic atrial fibrillation (NRAF) is a very common arrhythmia but its role in the prognosis and cardiovascular mortality is controversial. In particular, cause and predictors of death are not completely known.

METHODS

We analyzed the cause of death and the possible predictors of cardiovascular mortality in 664 outpatients (mean age 72 +/- 9 years old) enrolled in the "Trieste Area Study on Non-Rheumatic Atrial Fibrillation" (TASAF), a prospective community study, after a follow-up of 27 +/- 9 months. The mean duration of the arrhythmia at enrollment was 59 months (range 1-360 months). Only 42 patients (6.3%) were on anticoagulants by general practitioners and 205 (30.8%) were on antiplatelet drugs.

RESULTS

Of these patients, 110 (16.5%) died: 28 (25.5%) due to a cerebral or peripheral thromboembolism, 10 (8.2%) of sudden death, 46 (42.7%) of expected cardiac death and 25 (22.7%) of non-cardiac causes. In one patient, the cause of death was uncertain. Sixty-nine patients underwent postmortem examination. In univariate analysis, left ventricular dysfunction (p = 0.03) and an enlarged left atrium (p = 0.03) proved to be directly related to increased cardiovascular mortality. Both in univariate and Cox proportional hazards model analysis, aging (odds ratio 1.09, IC 95% 1.05-1.12, p = 0.00001), history of heart failure (odds ratio 1.27, IC 95% 1.01-1.60, p = 0.036), cardiomegaly (odds ratio 1.35, IC 95% 1.01-1.81, p = 0.040), diabetes mellitus (odds ratio 1.35, IC 95% 0.99-1.84, p = 0.058) and previous myocardial infarction (odds ratio 1.56, IC 95% 1.20-2.03, p = 0.0007) were all independent risk factors for cardiovascular mortality. A history of cerebral or systemic embolism (23 versus 12%, p = 0.09) and, above all, one or more recurrences before enrollment (11 versus 2.3%, p = 0.04), were associated with embolic mortality.

CONCLUSIONS

Patients with NRAF have an increased risk of cardiovascular death. Aging, the presence of diabetes, cardiomegaly on chest x-ray, heart failure and a previous myocardial infarction were independent risk factors for cardiovascular mortality. A history of embolism at enrollment significantly conditioned the embolic mortality rate but above all, embolic events during follow-up determined a very high percentage of total deaths (25.5% of all causes). A proper anticoagulant therapy should strongly be advised to all patients with no contraindications.

Authors+Show Affiliations

Cardiovascular Center, Maggiore Hospital, University of Trieste.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng ita

PubMed ID

10396667

Citation

Scardi, S, et al. "Mortality and Cause of Death in Patients With Chronic Non-rheumatic Atrial Fibrillation After a Two-year Follow-up." Giornale Italiano Di Cardiologia, vol. 29, no. 6, 1999, pp. 637-46.
Scardi S, Mazzone C, Pandullo C, et al. Mortality and cause of death in patients with chronic non-rheumatic atrial fibrillation after a two-year follow-up. G Ital Cardiol. 1999;29(6):637-46.
Scardi, S., Mazzone, C., Pandullo, C., Goldstein, D., Di Lenarda, A., & Chersevani, D. (1999). Mortality and cause of death in patients with chronic non-rheumatic atrial fibrillation after a two-year follow-up. Giornale Italiano Di Cardiologia, 29(6), 637-46.
Scardi S, et al. Mortality and Cause of Death in Patients With Chronic Non-rheumatic Atrial Fibrillation After a Two-year Follow-up. G Ital Cardiol. 1999;29(6):637-46. PubMed PMID: 10396667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality and cause of death in patients with chronic non-rheumatic atrial fibrillation after a two-year follow-up. AU - Scardi,S, AU - Mazzone,C, AU - Pandullo,C, AU - Goldstein,D, AU - Di Lenarda,A, AU - Chersevani,D, PY - 1999/7/9/pubmed PY - 1999/7/9/medline PY - 1999/7/9/entrez SP - 637 EP - 46 JF - Giornale italiano di cardiologia JO - G Ital Cardiol VL - 29 IS - 6 N2 - BACKGROUND: Non-rheumatic atrial fibrillation (NRAF) is a very common arrhythmia but its role in the prognosis and cardiovascular mortality is controversial. In particular, cause and predictors of death are not completely known. METHODS: We analyzed the cause of death and the possible predictors of cardiovascular mortality in 664 outpatients (mean age 72 +/- 9 years old) enrolled in the "Trieste Area Study on Non-Rheumatic Atrial Fibrillation" (TASAF), a prospective community study, after a follow-up of 27 +/- 9 months. The mean duration of the arrhythmia at enrollment was 59 months (range 1-360 months). Only 42 patients (6.3%) were on anticoagulants by general practitioners and 205 (30.8%) were on antiplatelet drugs. RESULTS: Of these patients, 110 (16.5%) died: 28 (25.5%) due to a cerebral or peripheral thromboembolism, 10 (8.2%) of sudden death, 46 (42.7%) of expected cardiac death and 25 (22.7%) of non-cardiac causes. In one patient, the cause of death was uncertain. Sixty-nine patients underwent postmortem examination. In univariate analysis, left ventricular dysfunction (p = 0.03) and an enlarged left atrium (p = 0.03) proved to be directly related to increased cardiovascular mortality. Both in univariate and Cox proportional hazards model analysis, aging (odds ratio 1.09, IC 95% 1.05-1.12, p = 0.00001), history of heart failure (odds ratio 1.27, IC 95% 1.01-1.60, p = 0.036), cardiomegaly (odds ratio 1.35, IC 95% 1.01-1.81, p = 0.040), diabetes mellitus (odds ratio 1.35, IC 95% 0.99-1.84, p = 0.058) and previous myocardial infarction (odds ratio 1.56, IC 95% 1.20-2.03, p = 0.0007) were all independent risk factors for cardiovascular mortality. A history of cerebral or systemic embolism (23 versus 12%, p = 0.09) and, above all, one or more recurrences before enrollment (11 versus 2.3%, p = 0.04), were associated with embolic mortality. CONCLUSIONS: Patients with NRAF have an increased risk of cardiovascular death. Aging, the presence of diabetes, cardiomegaly on chest x-ray, heart failure and a previous myocardial infarction were independent risk factors for cardiovascular mortality. A history of embolism at enrollment significantly conditioned the embolic mortality rate but above all, embolic events during follow-up determined a very high percentage of total deaths (25.5% of all causes). A proper anticoagulant therapy should strongly be advised to all patients with no contraindications. SN - 0046-5968 UR - https://www.unboundmedicine.com/medline/citation/10396667/Mortality_and_cause_of_death_in_patients_with_chronic_non_rheumatic_atrial_fibrillation_after_a_two_year_follow_up_ L2 - https://medlineplus.gov/atrialfibrillation.html DB - PRIME DP - Unbound Medicine ER -