Department of Medicine, Division of Cardiovascular Medicine; Department of Quantitative Health Sciences; Department of Neurology
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Health Services Administration
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.
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
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 of atrial fibrillation
Kundu A, Day KO, Lessard DM, Gore JM, Yu H, Akhter MW, Fisher DZ, Hayward RM, Henninger N, Kapoor A, Yarzebski JL, Goldberg RJ, McManus DD. (2018). Recent Trends in Oral Anticoagulant Use and Post-Discharge Complications Among Atrial Fibrillation Patients with Acute Myocardial Infarction. Population and Quantitative Health Sciences Publications. https://doi.org/10.4022/jafib.1749. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1212