Cause of death and predictors of all-cause mortality in anticoagulated patients with nonvalvular atrial fibrillation: Data from ROCKET AF

ROCKET AF Steering Committee and Investigators

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intentionto- treat population. The median age was 73 years, and the mean CHADS2 score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P<0.0001) were associated with higher all-cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C-index 0.677). Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.

Original languageEnglish (US)
Article numbere002197
JournalJournal of the American Heart Association
Volume5
Issue number3
DOIs
StatePublished - 2015
Externally publishedYes

Fingerprint

Atrial Fibrillation
Cause of Death
Mortality
Embolism
Stroke
Warfarin
Chronic Obstructive Pulmonary Disease
Heart Failure
Factor Xa
Vitamin K
Peripheral Vascular Diseases
Random Allocation
Treatment Failure
Population
Creatinine
Kidney
Survival
Rivaroxaban

Keywords

  • Atrial fibrillation
  • Mortality
  • Rivaroxaban
  • Stroke
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cause of death and predictors of all-cause mortality in anticoagulated patients with nonvalvular atrial fibrillation : Data from ROCKET AF. / ROCKET AF Steering Committee and Investigators.

In: Journal of the American Heart Association, Vol. 5, No. 3, e002197, 2015.

Research output: Contribution to journalArticle

@article{e660349d798642dcae165de80d95dfd9,
title = "Cause of death and predictors of all-cause mortality in anticoagulated patients with nonvalvular atrial fibrillation: Data from ROCKET AF",
abstract = "Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intentionto- treat population. The median age was 73 years, and the mean CHADS2 score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6{\%}) patients died. Kaplan-Meier mortality rates were 4.2{\%} at 1 year and 8.9{\%} at 2 years. The majority of classified deaths (1081) were cardiovascular (72{\%}), whereas only 6{\%} were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95{\%} CI 1.33-1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95{\%} CI 1.51-1.90, P<0.0001) were associated with higher all-cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C-index 0.677). Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.",
keywords = "Atrial fibrillation, Mortality, Rivaroxaban, Stroke, Warfarin",
author = "{ROCKET AF Steering Committee and Investigators} and Pokorney, {Sean D.} and Piccini, {Jonathan P.} and Stevens, {Susanna R.} and Patel, {Manesh R.} and Pieper, {Karen S.} and Halperin, {Jonathan L.} and G{\"u}nter Breithardt and Singer, {Daniel E.} and Hankey, {Graeme J.} and Werner Hacke and Becker, {Richard C.} and Berkowitz, {Scott D.} and Nessel, {Christopher C.} and Mahaffey, {Kenneth W.} and Fox, {Keith A A} and Califf, {Robert M.} and J. Anderson and N. Bedwell and Bilsker, {Martin S} and G. Bruce and R. Agah and M. DeSantis and S. Eisenberg and A. Flores and W. Herzog and S. Klein and H. Snyder and S. Krueger and E. Almaguer and E. Lavie and C. Lee and G. Mallis and M. Modi and G. Woodworth and I. Niazi and B. Peart and S. Sundaram and B. Snoddy and R. Sotolongo and J. Moloney and K. Vijayaraghavan and F. Whittier and L. Yellen and S. Banerjee and D. Lustgarten and D. Suresh and M. Gelernt and L. Levinson and R. Ghanekar and Seemant Chaturvedi",
year = "2015",
doi = "10.1161/JAHA.115.002197",
language = "English (US)",
volume = "5",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "3",

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TY - JOUR

T1 - Cause of death and predictors of all-cause mortality in anticoagulated patients with nonvalvular atrial fibrillation

T2 - Data from ROCKET AF

AU - ROCKET AF Steering Committee and Investigators

AU - Pokorney, Sean D.

AU - Piccini, Jonathan P.

AU - Stevens, Susanna R.

AU - Patel, Manesh R.

AU - Pieper, Karen S.

AU - Halperin, Jonathan L.

AU - Breithardt, Günter

AU - Singer, Daniel E.

AU - Hankey, Graeme J.

AU - Hacke, Werner

AU - Becker, Richard C.

AU - Berkowitz, Scott D.

AU - Nessel, Christopher C.

AU - Mahaffey, Kenneth W.

AU - Fox, Keith A A

AU - Califf, Robert M.

AU - Anderson, J.

AU - Bedwell, N.

AU - Bilsker, Martin S

AU - Bruce, G.

AU - Agah, R.

AU - DeSantis, M.

AU - Eisenberg, S.

AU - Flores, A.

AU - Herzog, W.

AU - Klein, S.

AU - Snyder, H.

AU - Krueger, S.

AU - Almaguer, E.

AU - Lavie, E.

AU - Lee, C.

AU - Mallis, G.

AU - Modi, M.

AU - Woodworth, G.

AU - Niazi, I.

AU - Peart, B.

AU - Sundaram, S.

AU - Snoddy, B.

AU - Sotolongo, R.

AU - Moloney, J.

AU - Vijayaraghavan, K.

AU - Whittier, F.

AU - Yellen, L.

AU - Banerjee, S.

AU - Lustgarten, D.

AU - Suresh, D.

AU - Gelernt, M.

AU - Levinson, L.

AU - Ghanekar, R.

AU - Chaturvedi, Seemant

PY - 2015

Y1 - 2015

N2 - Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intentionto- treat population. The median age was 73 years, and the mean CHADS2 score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P<0.0001) were associated with higher all-cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C-index 0.677). Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.

AB - Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intentionto- treat population. The median age was 73 years, and the mean CHADS2 score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P<0.0001) were associated with higher all-cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C-index 0.677). Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.

KW - Atrial fibrillation

KW - Mortality

KW - Rivaroxaban

KW - Stroke

KW - Warfarin

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U2 - 10.1161/JAHA.115.002197

DO - 10.1161/JAHA.115.002197

M3 - Article

C2 - 26955859

AN - SCOPUS:85006208431

VL - 5

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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