Atrial fibrillation and mortality in an elderly population. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. Kidney function and risk of cardiovascular disease and mortality in women: a prospective cohort study Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the Niigata preventive medicine study. The association between atrial fibrillation and sudden cardiac death: the relevance of heart failure. A longitudinal population-based study of prothrombotic factors in elderly subjects with atrial fibrillation: the Rotterdam Study 1990-1999. Obesity and outcomes among patients with established atrial fibrillation. Relation of Nonvalvular Atrial Fibrillation to Body Mass Index (from the SPORTIF Trials). Clinical Significance of Chronic Kidney Disease and Atrial Fibrillation on Morbidity and Mortality in Patients with Acute Myocardial Infarction Kidney function and discrimination of cardiovascular risk in middle-aged men. Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Causes of Death and Influencing Factors in Patients With Atrial Fibrillation: A Competing-Risk Analysis From the Randomized Evaluation of Long-Term Anticoagulant Therapy Study Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction. Relation of renal function to risk for incident atrial fibrillation in women. Analysis of Cause-Specific Mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction.
Prospect i ve data from Busselton , Western Australia , collected during triennial surveys from 1966 - 81 with follow-up of subjects to 1983 , showed that atrial fibrillation ( AF ) was frequent in elderly people and associated with increased mortality . Of 1770 people aged over 60 years , 40 were in atrial fibrillation when first seen and a further 47 developed it during follow-up . Atrial fibrillation was positively associated with angina , history of a myocardial infa rct ion and left bundle branch block . Relative mortality in those with atrial fibrillation compared with those without it , was 1.92 for all causes , 1.82 for death from cardiovascular causes ( excluding stroke ) and 3.78 for deaths from stroke , after adjustment by proportional hazards regression for confounding effects of age , sex , history of a myocardial infa rct ion , an abnormal electrocardiogram , angina , cholesterol level systolic blood pressure and Quetelet 's Index ( weight/height2 ) . The excess relative mortality declined with increasing age for both women and men . This raised relative mortality remained constant with time from the first detection of AF for all causes and cardiovascular causes but appeared to increase with time from detection for stroke death . The risk of death from stroke was greatest in the younger women . The observed risk of death from stroke in patients with AF suggests that anticoagulant use should be considered in selected patients OBJECTIVE This study undertook to determine if the presence of atrial fibrillation in patients with asymptomatic and symptomatic left ventricular dysfunction was associated with increased mortality and , if so , whether the increase could be attributed to progressive heart failure or arrhythmic death . BACKGROUND Atrial fibrillation is a common condition in heart failure with the potential to impact hemodynamics and progression of left ventricular systolic dysfunction as well as the electrophysiologic substrate for arrhythmias . The available data do not conclusively define the effect of atrial fibrillation on prognosis in heart failure . METHODS A retrospective analysis of the Studies of Left Ventricular Dysfunction Prevention and Treatment Trials was conducted that compared patients with atrial fibrillation to those in sinus rhythm at baseline  for the risk of all-cause mortality , progressive pump-failure death and arrhythmic death . RESULTS The patients with atrial fibrillation at baseline , compared to those in sinus rhythm , had greater all-cause mortality ( 34 % vs. 23 % , p < 0.001 ) , death attributed to pump-failure ( 16.7 % vs. 9.4 % , p < 0.001 ) and were more likely to reach the composite end point of death or hospitalization for heart failure ( 45 % vs. 33 % , p < 0.001 ) , but there was no significant difference between the groups in arrhythmic deaths . After multivariate analysis , atrial fibrillation remained significantly associated with all-cause mortality ( relative risk [ RR ] 1.34 , 95 % confidence interval [ CI ] 1.12 to 1.62 , p=0.002 ) , progressive pump-failure death ( RR 1.42 , 95 % CI 1.09 to 1.85 , p=0.01 ) , the composite end point of death or hospitalization for heart failure ( RR 1.26 , 95 % CI 1.03 to 1.42 , p=0.02 ) , but not arrhythmic death ( RR 1.13 ; 95 % CI 0.75 to 1.71 ; p=0.55 ) . CONCLUSIONS The presence of atrial fibrillation in patients with asymptomatic and symptomatic left ventricular systolic dysfunction is associated with an increased risk for all-cause mortality , largely explained by an increased risk for pump-failure death . These data suggest that atrial fibrillation is associated with progression of left ventricular systolic dysfunction Objective To evaluate the association of kidney function with  cardiovascular disease and mortality among apparently healthy women . Design Prospect i ve cohort study . Setting Women ’s Health Study , United States . Participants 27 939 female health professionals aged ≥45 who were free of cardiovascular disease and other major disease and who provided a blood sample at study entry . Main outcome measures Time to cardiovascular disease ( non-fatal stroke , non-fatal myocardial infa rct ion , coronary revascularisation procedures , or death from cardiovascular cause ) , specific cardiovascular disease events , and all-cause mortality . End points were confirmed after review of medical records and death certificates . Results Glomerular filtration rate ( GFR ) was estimated with the abbreviated Modification of Diet in Renal Disease Study equation . At baseline , 1315 ( 4.7 % ) women had GFR < 60 ml/min/1.73 m2 . During 12 years of follow-up , 1199 incident cardiovascular disease events and 856 deaths ( 179 from cardiovascular disease ) occurred . Compared with women with GFR ≥90 ml/min/1.73 m2 , the multivariable adjusted hazard ratios for any first cardiovascular disease were 0.95 ( 95 % CI 0.83 to 1.08 ) , 0.84 ( 0.70 to 1.00 ) , and 1.00 ( 0.79 to 1.27 ) among women with GFR of 75 - 89.9 , 60 - 74.9 , and < 60 ml/min/1.73 m2 , respectively ; the equivalent hazard ratios for all cause mortality were 0.93 ( 0.79 to 1.09 ) , 1.03 ( 0.85 to 1.26 ) , and 1.09 ( 0.83 to 1.45 ) . Similar null findings were observed for myocardial infa rct ion , stroke , coronary revascularisation , and non-cardiovascular death . However , an increased risk of death from cardiovascular disease was found among women with GFR < 60 ml/min/1.73 m2 ( hazard ratio 1.68 ( 1.02 to 2.79 ) ) . Conclusions In this large cohort of women , a glomerular filtration rate < 60 ml/min/1.73 m2 was associated with increased risk of cardiovascular disease death but not other cardiovascular disease events or non-cardiovascular disease mortality . We observed no increase in risk of any of the outcomes among women with less severe impairment of kidney function BACKGROUND Atrial fibrillation ( AF ) and chronic kidney disease share risk factors and pathophysiologic mechanisms , suggesting that two conditions have close relationships . METHODS This is a prospect i ve community-based observational cohort study including 235,818 subjects based upon a voluntary annual health check-up program in Japan . We studied the association of kidney dysfunction at entry with subsequent new-onset AF  and the association of AF at entry with the development of kidney disease . RESULTS During a follow-up of 5.9 + /- 2.4 years , AF developed in 2947 subjects ( 1.3 % ) .  Baseline serum creatinine and estimated glomerular filtration rate ( GFR ) were associated with risk of subsequent AF . The HRs ( 95 % CI ) for AF were 1.32 ( 1.08 - 1.62 ) and 1.57 ( 0.89 - 2.77 ) for GFR 30 to 59 and < 30 mL/min per 1.73 m(2 ) , respectively . The effect of kidney disease on risk of new-onset AF remained significant in subjects without treated hypertension or diabetes . During the follow-up , 7791 subjects ( 3.3 % ) developed kidney dysfunction ( GFR < 60 mL/min per 1.73 m(2 ) ) , and 11 307 subjects ( 4.9 % ) developed proteinuria .  Atrial fibrillation at entry was associated with development of kidney dysfunction ( HRs [ 95 % CI ] , 1.77 [ 1.50 - 2.10 ] ) and proteinuria ( HR [ 95 % CI ] , 2.20 [ 1.92 - 2.52 ] ) . The association persisted in subjects without treated hypertension or diabetes . CONCLUSIONS Kidney dysfunction increased the risk of new onset of AF , and AF increased the risk of development of kidney disease . This finding supports the concept that the two conditions share common abnormal molecular signaling pathways contributing to their pathogenesis OBJECTIVES The purpose of this study was to evaluate the role of congestive heart failure ( CHF ) in the association between  atrial fibrillation ( AF ) and sudden cardiac death ( SCD ) .  BACKGROUND Recent studies have reported the possibility of an independent association between AF and SCD . We hypothesized that a history of CHF is a significant confounder of this association . METHODS In a prospect i ve case-control analysis from the community ( The Oregon-SUDS [ Sudden Unexpected Death Study ] , 2002 to 2012 ) , SCD cases ( n = 652 ) with clinical records available ( including electrocardiography and /or echocardiography ) were compared with age- and sex-matched control patients with coronary artery disease . The association between AF and SCD was analyzed using multivariable logistic regression and propensity score matching . RESULTS Cases ( age 67.3 ± 11.7 years , 65 % male ) were more likely than control patients ( age 67.2 ± 11.4 years , 65 % male ) to have a history of AF ( p = 0.0001 ) , myocardial infa rct ion ( p = 0.007 ) , CHF ( p < 0.0001 ) , stroke ( p < 0.0001 ) , and diabetes ( p < 0.0001 ) . In multivariate analysis without considering CHF , AF was a significant predictor of SCD ( odds ratio [ OR ] : 1.6 ; 95 % confidence interval [ CI ] : 1.2 to 2.0 ; p = 0.002 ) . However , in a model that included CHF , the AF-SCD association was no longer significant ( OR : 1.1 ; 95 % CI : 0.8 to 1.5 ; p = 0.45 ) , whereas CHF was a significant predictor of SCD ( OR : 3.1 ; 95 % CI : 2.4 to 4.1 ; p < 0.0001 ) . Results on the basis of propensity score matching were consistent . CONCLUSIONS Our findings suggest that a history of CHF , including both systolic and diastolic symptomatic dysfunction , may partially explain the AF-SCD association BACKGROUND A prothrombotic or hypercoagulable state in atrial fibrillation may contribute to stroke and thromboembolism . Results of longitudinal population -based studies in elderly people with atrial fibrillation are not yet available . METHODS In the Rotterdam Study , a population -based prospect i ve cohort study , 162 participants with atrial fibrillation at baseline , aged 55 years and over , were matched for age and gender with 324 people in sinus rhythm . Associations were examined between three coagulation factors and the risk of total and cardiac mortality and stroke . Hazard rate ratios were calculated with 95 % confidence intervals using Cox 's proportional hazards model , adjusted for potential confounders . RESULTS Plasma von Willebr and factor was , age- and gender-adjusted , associated with cardiac mortality in the total population ( relative risk 1.16 ; 1.06 - 1.27 , per 10 IU dL(-1 ) increase ) , but statistical significance was lost after additional adjustments . A strong association ( 1.27 ; 1.08 - 1.50 , per 5-unit increase ) was found between soluble P-selectin ( sP-sel ) and cardiac mortality in atrial fibrillation patients but not in participants in sinus rhythm . Furthermore , the expected association between fibrinogen and cardiac mortality was observed only in those in sinus rhythm ( 2.60 ; 1.69 - 4.01 , per unit increase ) , and not in atrial fibrillation . No associations were found between coagulation factors and stroke . CONCLUSIONS In this population -based study , plasma levels of sP-sel predicted clinical adverse outcomes in atrial fibrillation , suggesting a role of platelets in the prothrombotic state associated with atrial fibrillation . Fibrinogen was a risk factor of cardiac and all-cause mortality in sinus rhythm , but not in atrial fibrillation Atrial fibrillation ( AF ) and obesity have reached epidemic proportions . The impact of obesity on clinical outcomes in patients with established AF is unknown . We analyzed 2,492 patients in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management ( AFFIRM ) study .  Body mass index ( BMI ) was evaluated as a categorical variable ( normal 18.5 to < 25 kg/m(2 ) , overweight 25 to < 30 kg/m(2 ) , obese > or=30 kg/m(2 ) ) . Rate of death from any cause was higher in the normal BMI group ( 5.8 per 100 patient-years ) than in the overweight and obese groups ( 3.9 and 3.7 , respectively ) . Cardiovascular death rate was highest in the normal BMI group ( 3.1 per 100 patient-years ) , lowest in the overweight group ( 1.5 per 100 patient-years ) , and intermediate in the obese group ( 2.1 per 100 patient-years ) . After adjustment for baseline factors , differences in risk of death from any cause were no longer significant . However , overweight remained associated with a lower risk of cardiovascular death ( hazard ratio 0.47 , p = 0.002 ) . Obese patients were more likely to have an uncontrolled heart rate at rest , but rhythm-control strategy success was similar across BMI categories . In each BMI category , risk of death from any cause was similar for patients r and omized to a rhythm- or rate-control strategy . In conclusion , in patients with established AF , overweight and obesity do not adversely affect overall survival . Obesity does not appear to affect the relative benefit of a rate- or rhythm-control strategy Obesity is well-established as a major cardiovascular ( CV ) risk factor . Obesity confers a greater risk for developing atrial fibrillation ( AF ) , but the relation between obesity and established nonvalvular AF for stroke and all-cause death is still unclear . To ascertain the prevalence of overweight and obesity in patients with nonvalvular AF , their influence on adverse events , and the relation with anticoagulation control , we performed this post hoc analysis of the pooled Stroke Prevention using an Oral Thrombin Inhibitor in patients with atrial Fibrillation ( SPORTIF ) III and V data sets . For this study , we analyzed all patients assigned to the warfarin arm with data on body mass index ( BMI ) . Time in therapeutic range was used as an index of the quality of anticoagulation control . The 3,630 patients eligible for this analysis were categorized as follows : ( 1 ) BMI 18.5 to 24.9 ( " normal weight " ) in 24.1 % ; ( 2 ) BMI 25.0 to 29.9 ( " overweight " ) in 39.8 % ; and BMI ≥30 ( " obese " ) in 36.1 % . Both overweight ( hazard ratio [ HR ] 0.70 ) and obese ( HR 0.59 ) categories were inversely associated with the composite outcome of stroke/all-cause death . A similar inverse association was seen for the end point of stroke ( HR 0.61 and 0.47 , respectively ) . Good anticoagulation control also attenuated the association between BMI categories and outcomes . In patients with time in therapeutic range > 70 % , BMI category was not significantly associated with the composite outcome of stroke/death and stroke . Stroke and all-cause death progressively reduced in overweight and obese anticoagulated patients with AF . The inverse relation of BMI categories to the risk of stroke and all-cause death was mitigated by good anticoagulation control Background / Aims : Atrial fibrillation ( AF ) often coexists with acute myocardial infa rct ion ( AMI ) , and chronic kidney disease ( CKD ) is a major risk for AMI . However , the combined impact of CKD and AF on the mortality and morbidity in AMI population has not been determined . Methods : Between January 2004 and December 2009 , a total of 4,738 AMI patients were enrolled prospect ively . Patients were divided into four groups according to the combined status of CKD and AF . The primary endpoint was a combination of 5-year major adverse cardiac and cerebrovascular events ( MACCE ) . Results : The prevalence of AF was significantly higher in CKD patients than in non-CKD patients ( 6.76 vs. 3.31 % , p < 0.001 ) . The highest cumulative event rate of MACCE and death was observed in patients with both CKD and AF ( 68.5 and 64.0 % ) , respectively . In multivariable analyses , compared with patients with neither AF nor CKD , hazard ratios ( HR ) for composite of MACCE were 1.66 ( 95 % CI , 1.14 - 2.41 ) , 1.24 ( 95 % CI , 1.06 - 1.46 ) , and 2.10 ( 95 % CI , 1.42 - 3.13 ) for patients with AF only , those with CKD only , and those with both CKD and AF , respectively ( p for interaction = 0.935 ) . Patients with both CKD and AF had a greatest risk for all-cause mortality ( HR 2.54 ; 95 % CI , 1.60 - 4.53 ) , and the significant synergistic interaction was observed between CKD and AF ( p for interaction = 0.015 ) . Conclusion : The combined effect of AF and CKD on the risk of MACCE after an AMI is stronger than any separate condition , and it confers a synergistic effect on the all-cause mortality risk OBJECTIVE To define the optimal glomerular filtration rate ( GFR ) cut off for discriminating the risk of myocardial infa rct ion or cardiovascular death . DESIGN Prospect i ve longitudinal observational study . SETTING A community-based cohort . PARTICIPANTS A total of 2176 nondiabetic 50-year-old men without cardiovascular disease . METHODS The men were followed until age 70 . GFR was estimated at baseline using the Cockcroft-Gault formula . The optimal GFR cut-off points for discriminating risk of a fatal or nonfatal myocardial infa rct ion and cardiovascular death were defined as the GFR levels maximizing integrated discrimination improvement ( IDI ) . MAIN OUTCOME MEASURES Fatal or nonfatal myocardial infa rct ion , cardiovascular death . RESULTS During follow-up , 264 men experienced a fatal or nonfatal myocardial infa rct ion , and 218 died of cardiovascular disease . The IDI-defined optimal GFR cut offs in this study were 98 mL min(-1 ) for discriminating myocardial infa rct ion risk and 92 mL min(-1 ) for discriminating risk of cardiovascular death . In Cox proportional hazard models adjusting for established risk factors , the myocardial infa rct ion risk was substantially higher in men with GFR below versus above 98 mL min(-1 ) [ hazard ratio ( HR ) 1.7 , 95 % confidence interval ( CI ) 1.3 - 2.3 , P < 0.001 ] , and the risk of cardiovascular death was doubled in men with GFR below versus above 92 mL min(-1 ) ( HR 2.1 , 95 % CI 1.5 - 3.0 , P < 0.001 ) . CONCLUSION The GFR cut-off point for optimal discrimination of cardiovascular risk in the general population may be higher than previously suggested BACKGROUND The aging population has result ed in more patients living with cardiovascular disease , such as atrial fibrillation ( AF ) . Recent focus has been placed on underst and ing the long-term consequences of chronic cardiovascular disease , such as a potential increased risk of dementia . OBJECTIVE This study sought to determine whether there is an association between AF and dementia and whether their coexistence is an independent marker of risk . METHODS A total of 37,025 consecutive patients from the large ongoing prospect i ve Intermountain Heart Collaborative Study data base were evaluated and followed up for a mean of 5 years for the development of AF and dementia . Dementia was sub-typed into vascular ( VD ) , senile ( SD ) , Alzheimer 's ( AD ) , and nonspecified ( ND ) . RESULTS Of the 37,025 patients with a mean age of 60.6 + /- 17.9 years , 10,161 ( 27 % ) developed AF and 1,535 ( 4.1 % ) developed dementia ( 179 VD , 321 SD , 347 AD , 688 ND ) during the 5-year follow-up . Patients with dementia were older and had higher rates of hypertension , coronary artery disease , renal failure , heart failure , and prior strokes . In age-based analysis , AF independently was significantly associated with all dementia types . The highest risk was in the younger group ( < 70 ) . After dementia diagnosis , the presence of AF was associated with a marked increased risk of mortality ( VD : hazard ratio [ HR ] = 1.38 , P = .01 ; SD : HR = 1.41 , P = .001 ; AD : HR = 1.45 ; ND : HR = 1.38 , P < .0001 ) . CONCLUSION AF was independently associated with all forms of dementia . Although dementia is strongly associated with aging , the highest risk of AD was in the younger group , in support of the observed association . The presence of AF also identified dementia patients at high risk of death Atrial  fibrillation ( AF ) is a common arrhythmia in elderly persons and a common cause of embolic stroke . Most studies of the prevalence and correlates of AF have used selected , hospital-based population s. The Cardiovascular Health Study is a population -based , longitudinal study of risk factors for coronary artery disease and stroke in 5,201 men and women aged > or = 65 years .  AF  was diagnosed in 4.8 % of women and in 6.2 % of men at the baseline examination , and prevalence was strongly associated with advanced age in women . Prevalence of AF  was 9.1 % in men and women with clinical cardiovascular disease , 4.6 % in patients with evidence of sub clinical but no clinical cardiovascular disease , and only 1.6 % in subjects with neither clinical nor sub clinical cardiovascular disease . A history of congestive heart failure , valvular heart disease and stroke , echocardiographic evidence of enlarged left atrial dimension , abnormal mitral or aortic valve function , treated systemic hypertension , and advanced age were independently associated with the prevalence of AF .  The low prevalence of AF in the absence of clinical and sub clinical cardiovascular disease calls into question the existence and clinical usefulness of the concept of so-called " lone atrial fibrillation " in the elderly Background — Atrial fibrillation is associated with increased mortality , but the specific causes of death and their predictors have not been described among patients on effective anticoagulant therapy . Methods and Results — The R and omized Evaluation of Long-Term Anticoagulant Therapy ( RE-LY ) trial r and omized 18 113 patients ( age , 71.5±9 years ; male , 64 % ; CHADS2 score , 2.1±1 ) to receive dabigatran or warfarin .  Median follow-up was 2 years , and complete follow-up was achieved in 99.9 % of patients . All deaths were categorized by the investigators using prespecified definitions followed by central adjudication . Overall , 1371 deaths occurred ( annual mortality rate , 3.84 % ; 95 % confidence interval [ CI ] , 3.64–4.05 ) . Cardiac deaths ( sudden cardiac death and progressive heart failure ) accounted for 37.4 % of all deaths , whereas stroke- and hemorrhage-related deaths represented 9.8 % of the total mortality . An examination of the causes of death according to dabigatran or warfarin showed that dabigatran significantly reduced vascular ( embolism and hemorrhage-related ) mortality ( relative risk , 0.63 ; 95 % CI , 0.45–0.88 ; P=0.007 ) , whereas other causes of death were similar between treatments , including cardiac mortality ( relative risk , 0.96 ; 95 % CI , 0.80–1.15 ; P=0.638 ) . The two strongest independent predictors of cardiac death in this population were heart failure ( hazard ratio , 3.02 ; 95 % CI , 2.45–3.73 ; P<0.0001 ) , and prior myocardial infa rct ion ( hazard ratio , 2.05 ; 95 % CI , 1.61–2.62 ; P<0.0001 ) . Conclusions — The majority of deaths are not related to stroke in a contemporary anticoagulated atrial fibrillation population . These results emphasize the need to identify interventions beyond effective anticoagulation to further reduce mortality in atrial fibrillation . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00262600 AIMS To characterize the relationship between known and newly diagnosed atrial fibrillation ( AF ) and the risk of death and major cardiovascular ( CV ) events in patients with acute myocardial infa rct ion ( MI ) complicated by heart failure ( HF ) and /or left ventricular systolic dysfunction ( LVSD ) . METHODS The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and /or LVSD .  AF was assessed at presentation and at r and omization ( median 4.9 days after symptom onset ) . Primary outcomes were risk of death and major CV events 3 years following acute MI . RESULTS A total of 1812 with current AF ( AF between presentation and r and omization ) , 339 patients with prior AF ( history of AF without current AF ) , and 12,509 without AF were enrolled . Patients with AF were older ; had more prior HF , angina , and MI , and received beta-blockers and thrombolytics less often than those without AF . Three-year mortality estimates were 20 % in those without AF , 37 % with current AF , and 38 % with prior AF . Compared with patients without AF , the multivariable adjusted HR of death was 1.25 ( 1.03 - 1.52 ; p=0.03 ) for prior AF and 1.32 ( 1.20 - 1.45 ; p<0.0001 ) for current AF . HR for major CV events was 1.15 ( 0.98 - 1.35 ; p=0.08 ) and 1.21 ( 1.12 - 1.31 ; p<0.0001 ) . CONCLUSION AF is associated with greater long-term mortality and adverse CV events with acute MI complicated by HF or LVSD Few prospect i ve studies have explored the association between renal function and risk for  incident atrial fibrillation ( AF ) in apparently healthy population s. A total of 24,746 women participating in the Women 's Health Study who were free of cardiovascular disease and AF and provided blood sample s at baseline were prospect ively followed for incident AF from 1993 to 2010 . AF events were confirmed by medical chart review . Estimated glomerular filtration rate ( eGFR ) was calculated from baseline creatinine using the Chronic Kidney Disease Epidemiology ( CKD-EPI ) equation . Cox models were used to estimate hazard ratios and 95 % confidence intervals ( CIs ) for incident AF across eGFR categories controlling for AF risk factors . During a median of 15.4 years of follow-up , 786 incident AF events occurred . The multivariate-adjusted hazard ratios for incident AF across eGFR categories ( < 60 , 60 to 74.9 , 75 to 89 , and ≥90 ml/min/1.73 m(2 ) ) were 1.36 ( 95 % CI 1.00 to 1.84 ) , 0.90 ( 95 % CI 0.71 to 1.14 ) , 0.99 ( 95 % CI 0.84 to 1.18 ) and 1.00 , respectively , without evidence of a linear association ( P for trend = 0.48 ) . Similarly , there was no significant curvilinear association ( quadratic p = 0.10 ) in multivariate analysis across categories . Compared to women with eGFRs ≥60 ml/min/1.73 m(2 ) , the 1,008 women with eGFRs < 60 ml/min/1.73 m(2 ) had a multivariate-adjusted hazard ratio for AF of 1.39 ( 95 % CI 1.04 to 1.86 , p = 0.03 ) . In conclusion , no significant linear or curvilinear relation was observed between incident AF and less severe impairment of renal function in this large prospect i ve cohort of women . However , a significant elevation in AF risk was observed at a threshold eGFR of < 60 ml/min/1.73 m(2 ) Background —Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study . This report describes the cause-specific modes of death in the AFFIRM treatment groups . Methods and Results —All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee , and a mode of death was assigned . In AFFIRM , 2033 patients were r and omized to a rhythm-control strategy and 2027 patients to a rate-control strategy .  During a mean follow-up of 3.5 years , there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients ( P = 0.07 ) . In the rhythm-control group , 129 patients ( 9 % ) died of a cardiac cause , and in the rate-control group , 130 patients ( 10 % ) died ( P = 0.95 ) . Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths . The numbers of vascular deaths were similar in the 2 groups : 35 ( 3 % ) in the rhythm-control group and 37 ( 3 % ) in the rate-control group ( P = 0.82 ) . There were no differences in the rates of ischemic stroke and central nervous system hemorrhage . In the rhythm-control group , there were 169 noncardiovascular deaths ( 47.5 % of the total number of deaths ) , whereas in the rate-control arm , there were 113 noncardiovascular deaths ( 36.5 % of the total number of deaths ) ( P = 0.0008 ) . Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths . Conclusions —Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate AIMS Atrial fibrillation ( AF ) is a common complication in patients with acute myocardial infa rct ion and is associated with an increase in the risk of death . The excess mortality associated with AF complicating acute myocardial infa rct ion has not been studied in detail . Observations indicate that AF facilitates induction of ventricular arrhythmias , which may increase the risk of sudden cardiovascular death ( SCD ) . A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments . METHODS AND RESULTS We analysed the relation between AF/atrial flutter ( AFL )  and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infa rct ion screened in the TR And olapril Cardiac Evaluation registry . This cohort of patients with an enzyme-verified acute myocardial infa rct ion was admitted to 27 centres in 1990 - 92 .  Survival status was obtained 2 years after screening of the last patient . An independent endpoint committee assessed the modes of death . Left ventricular ejection fraction was determined in all the screened patients and information about presence or absence of AF/AFL was prospect ively collected . Sustained or paroxysmal AF/AFL was observed in 1149 patients ( 19 % ) during hospitalization . During follow-up , 1659 patients ( 34 % ) died : 482 ( 50 % ) patients with AF/AFL and 1177 ( 30 % ) patients without AF/AFL , P<0.001 . SCD occurred in 536 , non-SCD occurred in 725 , and 398 died of non-cardiovascular causes ( includes 142 unclassifiable cases ) . The adjusted risk ratio of AF/AFL for total mortality was 1.33 ( 95 % CI : 1.19 - 1.49 ; P<0.0001 ) and the risk ratio for SCD was 1.31 ( 95 % CI : 1.07 - 1.60 ; P<0.009 ) . The adjusted risk ratio of AF/AFL for non-SCD was 1.43 ( 95 % CI : 1.21 - 1.70 ; P<0.0001 ) . CONCLUSION The excess mortality observed in patients with AF/AFL following acute myocardial infa rct ion is due to a significant increase in both SCD and non-SCD
Among the outcomes examined , the highest absolute risk increase was for heart failure .
Associations between atrial fibrillation and included outcomes were broadly consistent across subgroups and in sensitivity analyses .
Atrial fibrillation is associated with an increased risk of death and an increased risk of cardiovascular and renal disease .
OBJECTIVE To quantify the association between  atrial fibrillation and cardiovascular disease , renal disease , and death .