Abstract 210: Stroke-Related Specific Mortality and Influencing Factors in Patients with Atrial Fibrillation in the RE-LY Trial

Abstract

Background: Atrial fibrillation (AF) is associated with increased mortality, but the specific causes of death and their predictors have not been described. Methods and results: The Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial randomized 18,113 patients (71.5 ± 9 years, 64% males, CHADS 2 score 2.1 ± 1) to receive dabigatran or warfarin. Median follow-up was 2 years and complete follow-up was achieved in 99.9% of patients. All deaths were categorized by the investigators using pre-specified definitions followed by central adjudication. Overall, 1,371 deaths occurred (annual mortality rate of 3.84%, 95% CI 3.64-4.05). Cardiovascular death (sudden cardiac death [SCD] and progressive heart failure) accounted for 37.4% of all deaths, whereas stroke and hemorrhage-related represented only 9.8% of the total mortality. When examining causes of death according to dabigatran or warfarin, dabigatran only significantly affected stroke/hemorrhage-related mortality (RR 0.71, 95% CI 0.51-0.98, P = 0.04). The strongest independent predictor of cardiovascular death was heart failure (HR 2.45, 95% CI 2.10-2.88, P < 0.0001), of stroke-related deaths was non-fatal major hemorrhage (HR 4.35, 95% CI 2.58-7.34, P < 0.0001) and of hemorrhage-related deaths was non-fatal stroke (HR 3.80, 95% CI 1.07-13.5, P = 0.039). Conclusions: Among AF patients under antithrombotics, the majority of death (up to 90%) is due to causes other than stroke and bleeding. These results emphasize the need to identify interventions other than effective anticoagulation, which target SCD and progressive heart failure deaths in order to substantially reduce overall mortality, in AF patients. Clinical trial registration: ( http://www.clinicaltrials.gov ): Unique identifier NCT00262600 .