UMMS Affiliation

Department of Medicine, Division of Cardiovascular Medicine; Department of Quantitative Health Sciences; Department of Neurology

Publication Date

2018-02-28

Document Type

Article

Disciplines

Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Health Services Administration

Abstract

Background: Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI).The CHA2DS2VAScand CHADS2risk scoresare used to identifypatients with AF at risk for strokeand to guide oral anticoagulants (OAC) use, including patients with AMI. However, the epidemiology of AF, further stratifiedaccording to patients' risk of stroke, has not been wellcharacterized among those hospitalized for AMI.

Methods: We examined trends in the frequency of AF, rates of discharge OAC use, and post-discharge outcomes among 6,627 residents of the Worcester, Massachusetts area who survived hospitalization for AMI at 11 medical centers between 1997 and 2011.

Results: A total of 1,050AMI patients had AF (16%) andthe majority (91%)had a CHA2DS2VAScscore > 2.AF rates were highest among patients in the highest stroke risk group.In comparison to patients without AF, patients with AMI and AF in the highest stroke risk category had higher rates of post-discharge complications, including higher 30-day re-hospitalization [27 % vs. 17 %], 30-day post-discharge death [10 % vs. 5%], and 1-year post-discharge death [46 % vs. 18 %] (p < 0.001 for all). Notably, fewer than half of guideline-eligible AF patients received an OAC prescription at discharge. Usage rates for other evidence-based therapies such as statins and beta-blockers,lagged in comparison to AMI patients free from AF.

Conclusions: Our findings highlight the need to enhance efforts towards stroke prevention among AMI survivors with AF.

Keywords

Anticoagulation, Atrial Fibrillation, Epidemiology, Outcomes

Rights and Permissions

Journal of Atrial Fibrillation is an open access journal according to http://jafib.com/open_access.php. The license used is the Creative Commons Attribution 2.5 Generic license.

DOI of Published Version

10.4022/jafib.1749

Source

J Atr Fibrillation. 2018 Feb 28;10(5):1749. doi: 10.4022/jafib.1749. eCollection 2018 Feb. Link to article on publisher's site

Journal/Book/Conference Title

Journal of atrial fibrillation

PubMed ID

29988239

Comments

Full author list omitted for brevity. For the full list of authors, see article.

Related Resources

Link to Article in PubMed

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