Causes of death in Japanese patients with atrial fibrillation: The Fushimi AF Registry.

Aims: To investigate the causes of death and the associated clinical factors in patients with atrial fibrillation (AF) in the contemporary clinical practice.

Methods and Results: The Fushimi AF Registry is a community-based prospective survey of AF patients since March 2011 in Fushimi-ku, Kyoto. We investigated causes of death and the clinical indicators of cardiovascular (CV) and non-CV death in 4,045 patients with available follow-up data by the end of November 2016. The mean age was 73.6±10.9 years and the mean CHA2DS2-VASc score was 3.38±1.69. Oral anticoagulants (OAC) were prescribed in 55% of patients. During a median follow-up of 1,105 days, there were 705 all-cause deaths (5.5%/year); 180 CV (26% of total deaths), 381 non-CV (54%), and 144 undetermined causes (20%). The most common causes of CV and non-CV death were heart failure (14.5%), malignancy (23.1%) and infection/sepsis (17.3%), while mortality due to stroke was only 6.5%. Mortality due to infection/sepsis and undetermined causes increased with aging. On multivariate analysis, the strongest indicator of CV death was pre-existing heart failure (hazard ratio [HR]: 2.42, 95% confidence interval [CI]: 1.66-3.54, P < 0.001) and that of non-CV death was anemia (HR: 2.84, 95% CI: 2.22-3.65, P < 0.001).

Conclusions: In a Japanese community-based AF cohort, CV death was not mainly related to stroke but to heart failure. Non-CV death, mainly malignancy and infection, comprised more than a half of all deaths, which increased substantially in accordance with aging. Clinical factors that were associated with CV and non-CV death were distinct.