Abstract 15471: Risk Factors for Cause-Specific Mortality in Patients Anticoagulated for Atrial Fibrillation: Insights From the ARISTOTLE Trial
Background: While oral anticoagulation reduces the risk of stroke and stroke-related death in patients with atrial fibrillation (AF), the specific causes of death are poorly understood. We assessed causes of death and risk factors associated with cause-specific mortality in patients from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial.
Methods: 18,201 patients with AF and at least one stroke risk factor were enrolled in the ARISTOTLE trial. All deaths were centrally adjudicated by an events committee and classified as cardiovascular (CV) and non CV. CV deaths were further classified as related to heart failure (HF), stroke/systemic embolism, bleeding, or sudden cardiac (SCD). The median follow-up was 1.8 years. Fine-Gray subdistribution hazards model were used for analyses, with death from any other cause as a competing risk. Variables were selected based on known or suspected association with cause specific mortality.
Results: In total 1272 patients died: 652 (51%) CV; 32 (3%) bleeding; and 588 (46%) non-CV/non-bleeding deaths. Among CV deaths, there were 255 SCD (39%), 168 HF (26%) and 106 stroke (16%) deaths. Multivariable models identified predictors of cause specific death (table 1). History of HF, vascular disease, and age were the main risk factors for CV mortality. Older age and a history of HF were the strongest predictors of HF, SCD and stroke deaths; age was the only predictor of bleeding mortality. Randomization to apixaban versus warfarin reduced the risk of stroke death (hazard ratio 0.58, p=0.008). A sensitivity analysis confirmed these results.
Conclusions: In patients anticoagulated for AF, compared to warfarin, apixaban reduced the risk of stroke death; however, overall, SCD and HF deaths were more common than stroke deaths. Strategies to improve outcomes in patients anticoagulated for AF should include treatments to prevent deaths related to co-morbidities such as congestive HF.
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- © 2016 by American Heart Association, Inc.