Independent Predictors of Mortality in Patients with Nonvalvular Atrial Fibrillation: Results from ROCKET AF

Background: Atrial fibrillation (AF) is associated with increased mortality. Identification of contemporary risk factors for mortality may be helpful to guide interventions. Methods: In ROCKET AF, patients with nonvalvular AF were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination was used to identify the factors at randomization independently associated with the occurrence of all-cause death in the 14,171 intention to treat patients. Results: The median age was 73 yrs and the mean CHADS 2 score was 3.5. Over a median followup of 1.94 years, 1214 (8.6%) patients died. Among these patients, the median age was 76, mean CHADS 2 score was 3.6 and 48% had prior stroke or TIA. The independent, significant predictors of increased mortality were decreasing creatinine clearance, COPD, male sex, peripheral vascular disease, increasing age, diabetes, heart failure, tachycardia, residence in Latin America, and prior stroke/TIA (Table; C-index 0.6770). Alcohol use and higher body mass index were associated with a decreased risk of death. When baseline medications, including prior vitamin K antagonist (HR 0.77; 95% CI 0.68–0.87) and antiarrhythmic drug therapy (HR 1.04; 95% CI 0.87–1.24), were included as candidate variables the C-index improved to 0.6800. Conclusions: In a large population of patients with nonvalvular AF, the strongest predictors of mortality were reduced renal function, COPD, male sex, peripheral vascular disease, and age.