SOURCE: Fauchier L, Villejoubert O, Clementy N, et al. Causes of death and influencing factors in patients with atrial fibrillation. Am J Med 2016;129:1278-1287.

The advent of warfarin for anticoagulation in patients presenting with atrial fibrillation (AF) provided dramatic risk reductions; more than 60% reduced risk of ischemic stroke, and more than 25% reduced mortality. The addition of novel anticoagulants (factor Xa and antithrombin agents) reduces risk even more.

It may come as a surprise that of the 5.5% annual risk of death noted in a population of AF patients, the three most common causes of death were heart failure (29%), infection (18%), and cancer (12%).

Of course, anticoagulation does not totally eliminate stroke-related deaths in AF, not only because not all strokes may be caused by other disorders besides AF, but also because utilization of anticoagulants, particularly warfarin, also is imperfect.

Stroke and bleeding remain less frequent, but nonetheless important, causes of death in the AF population studied (n = 7,668), each accountable for 7% of deaths.

Although we have much to celebrate in the efficacy of established and novel treatments for stroke prevention in AF, the authors proposed that we might pay greater attention to prevention, identification, and management of heart failure, as it is the most frequent cause of death in patients presenting with AF.