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目的:分析接受抗凝治疗的非瓣膜性心房颤动（房颤）患者的死因构成，并探究其危险因素。方法:连续选取2011年8月至2018年12月中国心房颤动注册研究队列中服用抗凝药物的非瓣膜性房颤患者，在排除了肥厚型心肌病、扩张型心肌病及1年内失访的患者后，共纳入2 248例患者。对入组的患者进行随访，入组后第3、6个月进行随访，之后每6个月随访1次。终点事件为死亡，包括心血管病死亡、非心血管病死亡及原因不确定的死亡。根据随访结束后患者存活状态分为存活组和死亡组。收集患者的年龄、性别等临床资料，采用Cox回归分析全因死亡的危险因素，并使用Fine-Gray竞争风险模型分析心血管病死亡的危险因素。结果:共纳入2 248例接受抗凝治疗的房颤患者，年龄（67±10）岁，女性占比41.1%（923/2 248）。随访（42±24）个月，共有218例患者死亡，死亡率为2.8/100人年。最常见死因为心血管病死亡，占总死亡的55.0%（120/218），而心血管病死亡中首位死因为心力衰竭（心衰）恶化，占总死亡的18.3%（40/218），因缺血性卒中死亡者仅占总死亡的8.7%（19/218），因出血事件死亡者占总死亡的12.9%（28/218）。Cox回归分析显示，年龄（n HR=1.05，95%n CI 1.04~1.07，n P<0.001），贫血（n HR=1.81，95%n CI 1.02~3.18，n P=0.041），心衰（n HR=2.40，95%n CI 1.75~3.30，n P<0.001），缺血性卒中/短暂性脑缺血发作（TIA）（n HR=1.59，95%n CI 1.21~2.13，n P=0.001），心肌梗死（n HR=2.93，95%n CI 1.79~4.81，n P<0.001）是接受抗凝治疗的房颤患者全因死亡的危险因素。Fine-Gray竞争风险模型提示，年龄（n HR=1.05，95%n CI 1.02~1.08，n P<0.001），心衰（n HR=2.81，95%n CI 1.79~4.39，n P<0.001），缺血性卒中/TIA（n HR=1.50，95%n CI 1.02~2.22，n P=0.041），心肌梗死（n HR=3.31，95%n CI 1.72~6.37，n P<0.001）是接受抗凝治疗的房颤患者心血管病死亡的独立危险因素。n 结论:在接受抗凝治疗的非瓣膜性房颤患者中，缺血性卒中在死因中占比较小，而心衰恶化是最常见的心血管病死亡原因。心衰、缺血性卒中或TIA、心肌梗死与房颤患者死亡率高相关。“,”Objective:To investigate the causes of death and predictors in patients with nonvalvular atrial fibrillation (AF) undergoing anticoagulation therapy.Methods:Consecutive anticoagulated nonvalvular AF patients were recruited from the China Atrial Fibrillation Registry (China-AF) Study from August 2011 to December 2018. After exclusion of patients with hypertrophic cardiomyopathy, dilated cardiomyopathy, or loss of follow-up within 1 year, 2 248 patients were included in this analysis. Enrolled patients were followed up were followed up for 3 and 6 months, and then every 6 months. The primary endpoint was death, including cardiovascular death, non-cardiovascular death and undetermined death. The patients were divided into survival group and death group according to the survival status after follow-up. Clinical information such as age and sex was collected. Cox proportional hazards regression was performed to identify associated risk factors for all-cause mortality, and Fine-Gray competing risk model was used to identify associated risk factors for cardiovascular mortality.Results:A total of 2 248 patients with atrial fibrillation receiving anticoagulant therapy died over a mean follow-up of (42±24) months, mean age was (67±10) years old and 41.1% (923/2 248) patients were female. The mortality rate was 2.8 deaths per 100 patient-years. The most common cause of death was cardiovascular deaths, accounted for 55.0% (120/218). Worsening heart failure was the most common cause of cardiovascular deaths (18.3% (40/218)), followed by bleeding events (12.9% (28/218)) and ischemic stroke (8.7% (19/218)). Multivariate Cox regression analysis showed that age (n HR = 1.05, 95%n CI 1.04-1.07, n P<0.001), anemia (n HR = 1.81, 95%n CI 1.02-3.18, n P = 0.041), heart failure (n HR=2.40, 95%n CI 1.75-3.30, n P<0.001), ischemic stroke/transient ischemic attack (TIA)(n HR = 1.59, 95%n CI 1.21-2.13, n P = 0.001) and myocardial infarction (n HR = 2.93, 95%n CI 1.79-4.81, n P<0.001) were independently associated with all-cause death. Fine-Gray competing risk model showed that age (n HR=1.05, 95%n CI 1.02-1.08, n P<0.001), heart failure (n HR=2.81, 95%n CI 1.79-4.39, n P<0.001), ischemic stroke/TIA (n HR=1.50, 95%n CI 1.02-2.22, n P=0.041) and myocardial infarction (n HR=3.31, 95%n CI 1.72-6.37, n P<0.001) were independently associated with cardiovascular death.n Conclusions:In anticoagulated nonvalvular AF patients, ischemic stroke represents only a small subset of deaths, whereas worsening heart failure is the most common cause of cardiovascular deaths. Heart failure, ischemic stroke/TIA, and myocardial infarction are associated with increased mortality.