Hospitalizations for cardiovascular events and risk for all cause and cardiovascular mortality in elderly patients with atrial fibrillation treated with oral anticoagulants: beyond preventing thromboembolism.

BACKGROUND: Elderly patients with atrial fibrillation (AF) are at increased risk of death, despite oral anticoagulant (OAC) treatment. We estimated the risk of all cause and cardiovascular (CV) death associated with hospitalizations for cardiovascular events (CVEs). SETTING: Retrospective cohort study. METHODS: OAC treated patients (≥ 75 years) (n = 2161) discharged from a Swedish cardiology clinic with AF or atrial flutter (AFL) as main diagnosis between 2010 and 2017, were followed up for 12 months. Hospitalizations for CVEs were recorded from the national patient registry and diagnoses combined in five groups: heart failure (HF); stroke/ transient ischemic attack (TIA)/systemic embolism (SE); acute myocardial infarction and peripheral artery disease; bleeding; and other CVEs. We estimated the risk, expressed as hazard ratio (HR) and 95% confidence interval (CI) for all-cause and CV death in each hospitalization group by time-varying Cox regression. RESULTS: During 12 months of follow up, 178 patients died and 92 were CV deaths. Overall, 391 (18.5%) patients experienced a total of 490 hospitalizations for CVEs. Hospitalizations for any CVEs associated with increased risk (from 3 to 17 folds) for all-cause mortality. Risk for CV mortality increased in patients hospitalized for HF within 90 days (HR and 95%CI) 33.64 (15.97-70.89), for stroke/TIA/SE 14.73 (7.60-28.58) and for other CVEs 8.98 (4.29-18.78). CONCLUSIONS: Hospitalizations for CVEs in elderly AF/AFL OAC treated patients increased the risk for all cause and CV mortality within 12 months from admission for AF/AFL. Hospitalization for HF bared the highest risk, but the residual stroke/TIA/SE risk was noteworthy.