Incidence, type and prediction of death in anticoagulated patients with atrial fibrillation: a post-hoc analysis from the SPORTIF trials

Abstract Introduction Patients with atrial fibrillation (AF) are at substantially increased risk of death. Uncertainty still remains about the best risk tool to to stratify and predict mortality risk. Aim To report the incidence of death according to cause in anticoagulated AF patients. Second, to evaluate the predictive ability of several risk scores. Methods Patients from the warfarin arms of the SPORTIF trials were considered for analysis. All-cause death, cardiovascular (CV) death and non-CV death were study outcomes. The 2MACE score, crude number of diseases (CND), charlson comorbidity index (CCI) and GARFIELD-AF Death score were predictive tools. Results 3665 patients (mean [SD] age 70.9 [8.9] years. 69.5% males; median [IQR] CHA2DS2-VASc 3 [2–4]) were analysed. Median [IQR] scores were: 2MACE 2 [1–3]; CND 5 [3–7]; CCI 2 [1–3]. Throughout a median [IQR] of 567 [491–652] days there were 204 (5.6%) all-cause deaths, 134 (3.7%) CV deaths and 70 (1.9%) non-CV deaths. The incidence of all-cause death was 3.59 per 100 patient-years, and for CV death and non-CV death, 2.39 per 100 patient-years and 1.23 per 100 patient-years, respectively. Cumulative incidence of all cause, CV and non-CV deaths is are shown in the Figure. After multivariable adjustment, all the tools were found associated with an increased risk of all-cause death (2MACE HR: 1.28, 95% CI: 1.17–1.40; CND HR: 1.07, 95% CI: 1.04–1.11; CCI HR: 1.33, 95% CI: 1.22–1.44; GARFIELD-AF Death HR: 1.85, 95% CI: 1.52–2.26 per each 0.100 increase). Similar results were found for CV death and non-CV death. All risk tools were only modestly predictive of the three outcomes (c-indexes <0.7; Table). In predicting all-cause death, CCI and GARFIELD-AF Death were similarly predictive with small differences compared to other tools; conversely 2MACE and GARFIELD-AF Death showed similar predictive capacity for CV death, while CND and CCI had a slightly better predictivity for non-CV death. Conclusions AF patients have a high mortality, particularly for CV death. All risk scores are associated with occurrence of all-cause mortality, having a similar (but modest) predictive capacity. GARFIELD-AF Death and the simpler 2MACE had the highest predictive value for CV death, while multimorbidity tools (CND and CCI) were more predictive for Non-CV death. Cumulative Incidence of Death Events Funding Acknowledgement Type of funding source: None