Mortality and causes of death in patients with atrial fibrillation: A nationwide population-based study

Abstract

Background: Patients with atrial fibrillation are known to have a high risk of mortality. There is a paucity of population-based studies about the impact of atrial fibrillation on the mortality risk stratified by age, sex, and detailed causes of death.

Methods: A total of 15,411 patients with atrial fibrillation from the Korean National Health Insurance Service-National Sample Cohort were enrolled, and causes of death were identified according to codes of the 10th revision of the International Classification of Diseases.

Results: From 2002 to 2013, a total of 4,479 (29%) deaths were confirmed, and the crude mortality rate for all-cause death was 63.3 per 1,000 patient-years. Patients with atrial fibrillation had a 3.7-fold increased risk of all-cause death compared with the general population. The standardized mortality ratio for all-cause death was the highest in young patients and decreased with increasing age (standardized mortality ratio 21.93, 95% confidence interval 7.60-26.26 in patients aged <20 years; standardized mortality ratio 2.77, 95% confidence interval 2.63-2.91 in patients aged ≥80 years). Women with atrial fibrillation exhibited a greater excess mortality risk than men (standardized mortality ratio 3.81, 95% confidence interval 3.65-3.98 in women; standardized mortality ratio 3.35, 95% confidence interval 3.21-3.48 in men). Cardiovascular disease was the leading cause of death (38.5%), and cerebral infarction was the most common specific disease. Patients with atrial fibrillation had an about 5 times increased risk of death due to cardiovascular disease compared with the general population.

Conclusions: Patients with atrial fibrillation had a 4 times increased risk of mortality compared with the general population. However, the impact of atrial fibrillation on mortality decreased with age and in men. Cerebral infarction was the most common cause of death, and more attention should be paid to reducing the risk of stroke.

Fig 1. Mortality rates and standardized mortality ratios (SMR) of patients with atrial fibrillation (AF) according to age and sex.

(A) The mortality rates of patients with AF increased with age. Male patients with AF showed higher mortality rates than female patients with AF. (B) The SMR of patients with AF decreased with age. Female patients with AF showed higher SMR than male patients with AF.

Fig 2. Kaplan-Meier survival curves according to CHA₂DS₂-VASc score.

Survival rate was lower in atrial fibrillation patients with higher CHA₂DS₂-VASc score.

Fig 3. Mortality rates (MR) and standardized mortality ratios (SMR) of specific causes of death in atrial fibrillation patients according to ICD-10 codes.

The overall mortality rate (MR) was higher in men than in women, but the MR due to diseases of the circulatory system was lower in men. The SMRs were generally higher in women than in men except for malignant neoplasms and diseases of the respiratory system.