BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn 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 intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 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).ConclusionsIn 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.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

The CREATE-ECLA Randomized Controlled TrialThe CREATE-ECLA Trial Group Investigators* See also pp 427 and 489.

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This study examines the application of poultry eggshell (PES) as a source of calcium for the synthesis of hydroxyapatite (HA) via annealation. The synthesized powder (poultry eggshell hydroxyapatite (PESHA)) was characterized by X-ray diffraction (XRD), Fourier transform infrared (FTIR), scanning electron microscopy (SEM), EDAX, and transmission electron microscopy (TEM) analytical techniques. This powder was used for adsorptive removal of the Reactive Yellow 4 (RY4) dye in a batch process. Results from morphological analysis by SEM and TEM revealed that the microstructure of the apatite is made up of needle–rod-like particles with the length of 15–60 nm, breadth of 4–6 nm, and crystallite size of 86.32 nm. EDAX revealed that HA has Ca/P ratio of 1.63, indicating a nonstoichiometric apatite, whereas XRD analysis presented it as a pure monophasic hydroxyapatite powder. Fourier Transform Infrared (FTIR) spectroscopy indicated that the adsorption is due to the electrostatic interaction between the functional groups of the dye and those on the apatite surface. The maximum adsorption capacity ( Q max ) of 127.9 mg g –1 was obtained for the adsorption process, whereas the pseudo-first-order model with R 2 > 0.99 best described the adsorption mechanism. Furthermore, the thermodynamic studies revealed that the adsorption process was exothermic and spontaneous in nature with Δ H and Δ S values of 120.79 kJ mol –1 and 0.395 kJ mol –1 K –1 , respectively. Thus, hydroxyapatite fabricated from the poultry waste of eggshell can be effectively utilized as an excellent nontoxic and cheap adsorbent for the removal of RY4 dye from aqueous medium.