BackgroundsThe understanding of death in patients with atrial fibrillation (AF) in China is limited. This study aimed to assess the contemporary survival of AF patients in China and to explore risk factors for deaths.MethodsThis was a prospective community-based cohort study including 559 AF patients, who were followed-up from July 2015 to December 2020.ResultsDuring 66-month follow-up, there were 200 deaths (56.5% cardiovascular, 40.0% non-cardiovascular, and 3.5% unknown causes) among 559 AF patients with the median age of 76 years. The top three causes of death were heart failure (33.0%), ischemic stroke (17.0%) and cancer (16.5%). Multivariate Cox regression analysis indicated baseline variables positively associated with all-cause death were age (HR: 1.10, 95% CI: 1.08–1.13), AF subtype (HR: 1.37, 95% CI: 1.08–1.73), prior myocardial infarction (HR: 3.40, 95% CI: 1.48–7.78), previous tumor (HR: 2.61, 95% CI: 1.37–4.98), hypoglycemic therapy at baseline (HR: 1.81, 95% CI: 1.13–2.91), but body weight (HR: 0.98, 95% CI: 0.97–1.00) and use of calcium channel blocker (CCB) (HR: 0.62, 95% CI: 0.41–0.95) played a protective role to all-cause death. Of patients who were alive at the end of follow-up, 24.0% were on oral anticoagulants (OAC) alone, 4.5% on dual antithrombotic therapy, 33.1% on antiplatelet agents alone and 38.4% weren't on any antithrombotic medication.ConclusionIschemic stroke still remains one of the leading causes of death and OAC is seriously underused in AF patients in China. Independent risk factors for death are age, AF subtype, previous tumor, prior myocardial infarction, hypoglycemic therapy, low body weight and no CCB use.Clinical Trial Registrationhttp://www.chictr.org.cn/ (ChiCTR-ICR-15007036).

Background:China bears the biggest atrial fibrillation (AF) burden in the world. However, little is known about the incidence and predictors of AF. This study aimed to investigate the current incidence of AF and its electrocardiographic (ECG) predictors in general community individuals aged over 60 years in China.Methods:This was a prospective cohort study, recruiting subjects who were aged over 60 years and underwent annual health checkups from April to July 2015 in four community health centers in Songjiang District, Shanghai, China. The subjects were then followed up from 2015 to 2019 annually. Data on sociodemographic characteristics, medical history, and the resting 12-lead ECG were collected. Kaplan–Meier curve was used for showing the trends in AF incidence and calculating the predictors of AF. Associations of ECG abnormalities and AF incidence were examined using Cox proportional hazard models.Results:This study recruited 18,738 subjects, and 351 (1.87%) developed AF. The overall incidence rate of AF was 5.2/1000 person-years during an observation period of 67,704 person-years. Multivariable Cox regression analysis indicated age (hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.06–1.09; P < 0.001), male (HR, 1.30; 95% CI: 1.05–1.62; P = 0.018), a history of hypertension (HR, 1.55; 95% CI: 1.23–1.95; P < 0.001), a history of cardiac diseases (HR, 3.23; 95% CI: 2.34–4.45; P < 0.001), atrial premature complex (APC) (HR, 2.82; 95% CI: 2.17–3.68; P < 0.001), atrial flutter (HR, 18.68; 95% CI: 7.37–47.31; P < 0.001), junctional premature complex (JPC) (HR, 3.57; 95% CI: 1.59–8.02; P = 0.002), junctional rhythm (HR, 18.24; 95% CI: 5.83–57.07; P < 0.001), ventricular premature complex (VPC) (HR, 1.76; 95% CI: 1.13–2.75, P = 0.012), short PR interval (HR, 5.49; 95% CI: 1.36–22.19; P = 0.017), right atrial enlargement (HR, 6.22; 95% CI: 1.54–25.14; P = 0.010), and pacing rhythm (HR, 3.99; 95% CI: 1.57–10.14; P = 0.004) were independently associated with the incidence of AF.Conclusions:The present incidence of AF was 5.2/1000 person-years in the studied population aged over 60 years in China. Among various ECG abnormalities, only APC, atrial flutter, JPC, junctional rhythm, short PR interval, VPC, right atrial enlargement, and pacing rhythm were independently associated with AF incidence.