The impact of bleeding and comorbidities on the risk of mortality in patients with atrial fibrillation

Robert Kiss, Daniel Aradi, Gyorgy Rokszin, Ibolya Fabian, Csaba Andras Dezsi and Bela Merkely (Volume 73, Issue 9 Supplement 1, March 2019, DOI:



Atrial fibrillation (AF) is associated with an increased risk for mortality, stroke and bleeding. We aimed to investigate the impact of comorbidities and bleeding on the risk of all-cause mortality in patients with AF in Hungary.


Our retrospective observational study was conducted from 1st of January 2011 until 31 of December 2016. All patients with atrial fibrillation were recorded with at least one repetition of the main diagnosis within a period of 30 to 365 days after initial diagnosis. The Hungarian National Health Insurance Fund (NHIF) contains data on in-hospital, out-patient and prescription-related health records of more than 95% of Hungarian population since 1998. Data on comorbidities as well as all-cause mortality were obtained from NHIF.


During the study period, 239,703 patients were identified with AF. Compared to 2011, the proportion of elderly patients increased significantly until 2016. (p <0.001). Also, prior ischemic stroke and TIA subpopulation increased significantly (p<0.001) during research years. Comorbidities among atrial fibrillation patients, such as prior stroke, major bleeding, congestive heart failure, peripheral vascular disease, acute myocardial infarction increased the risk for mortality (Risk Ratio /RR/: 2.01, 2.12, 2.92, 2.36, and 1.68, respectively, all p<0.001). Coronary bypass surgery decreased the RR of crude mortality of patients with atrial fibrillation (0.80, p<0.01). Oral anticoagulants were prescribed for 82.7 % of the Hungarian atrial fibrillation population. Mortality risk was the highest among those atrial fibrillation patients, who did not receive oral anticoagulants but experienced an ischemic stroke (RR: 3.48), or myocardial infarction treated with primary percutaneous intervention (RR: 4.1) (both p<0.01).


The rate of comorbidities in patients with AF are significantly growing by time, resulting in a more and more vulnerable patient population. Also, co-morbidities were associated with all-cause mortality.