RECENT data from a 23-year Danish national cohort study reveal only modest gains in life expectancy following cardiovascular complications in patients with atrial fibrillation (AF), with little improvement seen for bleeding-related events.
AF is a common arrhythmia associated with substantial morbidity and mortality, largely due to complications such as stroke, heart failure (HF), myocardial infarction (MI), and major bleeding. To assess whether improvements in care have translated into better long-term outcomes, researchers in Denmark conducted a nationwide registry-based matched cohort study in patients diagnosed with AF between 2000 and 2022. The study examined differences in restricted mean survival time to estimate average life-years lost following key complications, including ischaemic stroke, gastrointestinal bleeding, intracranial bleeding, HF, and MI. Patients were grouped by time period (2000–2010 versus 2011–2022) to evaluate trends over time.
Across the study period, 27,809 patients with stroke, 28,938 with gastrointestinal bleeding, 7,710 with intracranial bleeding, 50,914 with HF, and 14,141 with MI were followed alongside matched AF controls without complications. Loss of life expectancy after stroke declined from 2.1 to 1.8 years (4.0 months gain; 95% CI: 2.4–5.6; P<0.001). Similarly, HF-related life loss reduced from 2.1 to 1.9 years (2.4 months gain; 95% CI: 0.9–3.8; P=0.001), and for MI from 1.6 to 1.1 years (5.9 months gain; 95% CI: 3.3–8.5; P<0.001). However, no significant improvements were observed for gastrointestinal bleeding (-1.7 vs -1.8 years; P=0.32) or intracranial bleeding (-3.3 vs -3.1 years; P=0.28), where survival losses remain substantial.
These findings suggest that, while some progress has been made in reducing mortality following major cardiovascular events in patients with AF, similar strides have not been achieved for bleeding complications. Further focus on prevention and mitigation of bleeding risk is essential to close this gap.
Reference
Vinter N et al. Temporal trends in loss of expected lifetime associated with cardiovascular complications following newly diagnosed atrial fibrillation: A Danish nationwide cohort study from 2000-2022. Eur Heart J Qual Care Clin Outcomes. 2025; DOI: 10.1093/ehjqcco/qcaf026.
