Oba Kageyuki, Shinjo Tetsuji, Tamashiro Masahiro, Matsuoka Mitsuteru, Arasaki Osamu, Arima Hisatomi, Inoue Taku
Cardiovascular Medicine, Tomishiro Central Hospital Okinawa Japan.
Cardiovascular Medicine, Nambu Hospital Okinawa Japan.
Circ Rep. 2020 Aug 29;2(9):490-498. doi: 10.1253/circrep.CR-20-0079.
Oral anticoagulant (OAC) therapy reduces the risk of stroke in patients with atrial fibrillation (AF). This study elucidated the causes of death and related factors in elderly Japanese AF patients. Over a median (interquartile range [IQR]) follow-up period of 46 (20-76) months, there were 171 all-cause deaths (28% cardiovascular, 46% non-cardiovascular, and 26% unknown causes) among 389 AF patients (median [IQR] age 80 [74-85] years; CHADDS-VASc score 5 [4-6]). Cox regression analysis indicated that diabetes was associated with an increase in all-cause death (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02-2.13), whereas hypercholesterolemia (HR 0.53; 95% CI 0.35-0.79), pre-existing heart failure (HR 0.67; 95% CI 0.48-0.95), and OAC use (HR 0.62; 95% CI 0.44-0.88) were associated with reductions in all-cause death. Pre-existing heart failure was associated with both cardiovascular (HR 3.03; 95% CI 1.33-8.20) and non-cardiovascular (HR 0.44; 95% CI 0.30-0.65) deaths, in opposite directions. OAC use was associated with a reduction in cardiovascular death (HR 0.34, 95% CI 0.17-0.69). The predominance of non-cardiovascular death and death-related factors were equivalent regardless of when observations started (before 2009 or in 2009 and later). The predominant cause of death in elderly Japanese AF patients was non-cardiovascular. Distinct clinical factors were associated with cardiovascular and non-cardiovascular death.
口服抗凝剂（OAC）治疗可降低心房颤动（AF）患者的中风风险。本研究阐明了日本老年AF患者的死亡原因及相关因素。在中位（四分位间距[IQR]）随访期46（20 - 76）个月内，389例AF患者（中位[IQR]年龄80[74 - 85]岁；CHADDS-VASc评分5[4 - 6]）中有171例全因死亡（28%为心血管原因，46%为非心血管原因，26%原因不明）。Cox回归分析表明，糖尿病与全因死亡增加相关（风险比[HR]1.48；95%置信区间[CI]1.02 - 2.13），而高胆固醇血症（HR 0.53；95% CI 0.35 - 0.79）、既往存在心力衰竭（HR 0.67；95% CI 0.48 - 0.95）和使用OAC（HR 0.62；95% CI 0.44 - 0.88）与全因死亡减少相关。既往存在心力衰竭与心血管死亡（HR 3.03；95% CI 1.33 - 8.20）和非心血管死亡（HR 0.44；95% CI 0.30 - 0.65）均相关，方向相反。使用OAC与心血管死亡减少相关（HR 0.34，95% CI 0.17 - 0.69）。无论观察从何时开始（2009年之前或2009年及以后），非心血管死亡的优势及死亡相关因素均相当。日本老年AF患者的主要死亡原因是非心血管性的。不同的临床因素与心血管死亡和非心血管死亡相关。
