PMC:99044 / 6899-13873 JSONTXT

{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/99044","sourcedb":"PMC","sourceid":"99044","source_url":"https://www.ncbi.nlm.nih.gov/pmc/99044","text":"Results\nDuring a mean follow-up of close to two years, 393 patients died in the general population cohort and 234 in the AF cohort. Patients with AF had a significantly lower survival than patients from the general population without AF (Figure 1). The increased mortality was already present in the early phase of follow-up. Half of the deaths in the AF cohort were related to ischaemic heart disease (IHD) or other cardiovascular diseases (45% of all cause mortality). In the general population cohort, these two causes accounted for 29% of all deaths (table 1). The relative risk of mortality among patients with chronic atrial fibrillation was 2.5 (95% CI 2.1–3.0) compared to the general population after adjusting for co-morbidity and major clinical risk factors (table 2). This risk was 2.3 (95% CI 1.8–3.0) in men and 2.8 (95% CI 2.2–3.6) in women. When considering only cerebro- and cardio-vascular deaths (n= 306), the corresponding adjusted RR associated with chronic AF was 3.7 (95% CI 3.0–4.7).\nFigure 1 Kaplan-Meier survival curve for chronic atrial fibrillation and general population cohorts. (mean follow-up time 22 months -SD 12.9; range: 0.5–47 months).\nTable 1 Distribution of causes of death in the cohort of chronic atrial fibrillation patients and the general population\nGeneral Population Cohort AF Cohort\nN = 393 % N = 234 %\nCauses of death\nIschaemic heart disease (IHD) 70 17.8 61 21.1\nOther cardiovascular no IHD * 42 10.7 56 24\nCerebrovascular disease† 44 11.2 33 14.1\nCancer 64 16.3 27 11.5\nOther diseases§ 107 27.2 48 20.5\nUnknown 66 16.8 9 3.8\n* Includes heart failure, heart valvular and rhythm disorders and vascular diseases (PVD, aneurism, pulmonary embolism). †includes ischaemic and haemorrhagic cerebrovascular accidents. §Includes respiratory, gastrointestinal, liver, renal diseases, infection and trauma.\nTable 2 Incidence rate and relative risk of death in the cohort of chronic atrial fibrillation patients compared to the general population\nGeneral Population Cohort AF Cohort\nPerson-years 9261 1898\nDeaths 393 234\nMortality rate/100 p-years (95% Cl) 4.2 (3.8–4.7) 12.3 (10.8–14.0)\nRelative Risk * (95% Cl) 1 2.5 (2.1 – 3.0)\n* Relative risk estimated by Cox regression including age, sex, smoking, diabetes, heart failure, 'Ischaemic heart disease, hypertension, cerebrovascular disease Table 3 shows the effect of several factors on the mortality risk in the cohort of chronic AF patients. The mortality risk increased remarkably with advancing age. Smokers carried a relative risk of dying close to threefold. Diabetes, heart failure and cerebrovascular disease were all associated with estimates of RR between 1.5 and 2. Ischaemic heart disease was the strongest clinical predictor of mortality with a RR of 3.0 (95% CI; 2.1–4.1). We did not find any significant association between alcohol consumption and mortality. Overweight patients (BMI of 30 or more) had a relative risk of 0.5 (95%CI: 0.3–0.9) compared to subjects with a BMI between 22 and 25 after adjusting for age, sex, smoking and preexisting conditions.\nTable 3 Risk of mortality associated with different risk factors among chronic atrial fibillation patients.\nCases Controls Odds Ratio*\nn = 234 (%) n = 801 (%) (95% CI)\nSex\nMales 115 (49.1) 372 (53.6) 1\nFemales 119 (50.9) 429 (46.4) 0.9 (0.6–1.3)\nAge\n40–59 years 4 (1.7) 67 (8.4) 1\n60–69 years 19 (8.1) 136 (17.0) 1.9 (0.6–5.9)\n70–79 years 93 (39.7) 325 (40.6) 4.0 (1.4 – 11.7)\n80–89 years 118 (50.4) 273 (34.1) 6.0 (2.0–17.6)\nSmoking status\nNever smoker 108 (46.2) 486 (60.7) 1\nSmoker 59 (25.2) 127 (15.9) 2.6 (1.7–4.0)\nEx-smoker 28 (12.0) 84 (10.5) 1.6 (0.9–2.7)\nUnknown 39 (16.7) 104 (13.0) 1.7 (1.0–2.9)\nBMI (weight /height2)\n\u003c22 30 (12.8) 82 (10.2) 1.0 (0.6–1.9)\n22–24.9 49 (20.9) 138 (17.2) 1\n25–30 60 (25.6) 227 (28.3) 0.8 (0.5–1.3)\n+30 20 (8.5) 131 (16.4) 0.5 (0.3–0.9)\nUnknown 75 (32.1) 223 (27.8) 0.9 (0.5–1.5)\nPrior co-morbidity\nDiabetes 30 (12.8) 59 (7.4) 2.1 (1.3–3.6)\nHeart Failure 137 (58.5) 271 (33.8) 1.9 (1.4–2.7)\nIschemic heart disease 127 (54.3) 206 (25.7) 3.0 (2.1 – 4.2)\nHypertension 104 (44.4) 355 (44.3) 0.9 (0.7–1.3)\nCerebrovascular disease 73 (31.2) 159 (19.9) 1.5 (1.1 – 2.2)\n*Estimates of risk are adjusted for all variables included in the table using logistic regression. Current use of calcium channel blockers, aspirin and warfarin were associated with a significant reduced risk of all cause mortality (Table 4). When we separated current use into short and long term use (less than 3 months of use versus more), we observed that the reduced risk of mortality was mainly among long-term users of these drugs. Users of calcium channel blockers for more than 3 months carried a risk of 0.4 (95%CI 0.2–0.7), the respective estimates for warfarin long term users was 0.4 (95%CI 0.3–0.8) and for aspirin (RR: 0.6; 95%CI 0.4–0.9). Current use of NSAIDs was associated with an increased mortality (RR of 1.8; 95% CI 1.0–3.2).\nTable 4 Risk of mortality associated with use of cardiovascular treatment drugs in the AF cohort\nCases Controls Odds Ratio*\nn = 234 (%) n = 801 (%) (95% CI)\nDiuretics\nNon use 46 (19.7) 237 (29.6) 1\nCurrent use 135 (57.7) 419 (52.3) 1.1 (0.6–1.7)\nPast use 53 (22.6) 145 (18.1) 1.1 (0.6–1.9)\nBeta Blockers\nNon use 169 (72.2) 561 (70.0) 1\nCurrent use 13 (5.6) 87 (10.9) 0.8 (0.4–1.6)\nPast use 52 (22.2) 153 (19.1) 1.0 (0.6–1.6)\nACE inhibitors\nNon use 137 (58.5) 524 (65.4) 1\nCurrent use 70 (29.9) 208 (26.0) 0.8 (0.5–1.3)\nPast use 27 (11.5) 69 (8.6) 1.0 (0.5–1.8)\nCalcium Channel\nBlockers\nNon use 165 (70.5) 560 (69.9) 1\nCurrent 18 (7.7) 125 (15.6) 0.4 (0.2–0.7)\nPast use 51 (21.8) 116 (14.5) 1.2 (0.7–1.8)\nDigoxin\nNon use 51 (21.8) 191 (23.8) 1\nCurrent 143 (61.1) 496 (61.9) 0.9 (0.6–1.4)\nPast use 40 (17.1) 114 (14.2) 1.0 (0.5–1.7)\nAmiodarone †\nNon use 212 (90.6) 726 (90.6) 1\nCurrent 14 (6.0) 44 (5.5) 1.3 (0.6–2.8)\nPast use 8 (3.4) 31 (3.9) 0.8 (0.3–2.2)\nWarfarin\nNon use 174 (74.4) 503 (62.8) 1\nCurrent 37 (15.8) 226 (28.2) 0.5 (0.3–0.8)\nPast use 23 (9.8) 72 (9.0) 1.0 (0.5–1.8)\nAspirin\nNon use 109 (46.6) 407 (50.8) 1\nCurrent 72 (30.8) 239 (29.8) 0.6 (0.4–0.9)\nPast use 53 (22.6) 155 (19.4) 0.8 (0.5–1.2)\n*Estimates are adjusted for age, sex, smoking, diabetes, heart failure, 'Ischaemic heart disease, hypertension, cerebrovascular disease and all the drugs groups in the table, using logistic regression. †There was no use of other antiarrhythmic drugs (disopyramide, procainamide, quinidine, flecainide and propafenone). The estimates of mortality risk for all risk factors evaluated only changed marginally when we restricted the analysis to cardiovascular deaths that included IHD, heart failure, other cardiovascular and cerebrovascular diseases (data not 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