UMMS Affiliation

Department of Medicine; Graduate School of Nursing; UMass Center for Clinical and Translational Science

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Translational Medical Research



Atrial fibrillation (AF) commonly occurs in the setting of acute conditions. We aimed to identify the acute conditions associated with secondary AF (AF precipitants) including pneumonia/sepsis, pneumothorax, respiratory failure, myocarditis, pericarditis, alcohol intoxication, thyrotoxicosis, cardiothoracic surgery, other surgery in patients with newly diagnosed AF and determine their association with subsequent oral anticoagulant use.

Methods and Results

We assembled a cohort of patients in the UMass Memorial Healthcare system with a new diagnosis of AF with and without AF precipitants. We used combinations of International Classification of Diseases, Tenth Revision (ICD-10) codes, Current Procedural Terminology codes, laboratory values, imaging reports, and physician notes including discharge summary texts to identify AF precipitants. We then manually reviewed the individual charts to validate presence of AF precipitants. The study sample consisted of 185 patients with and 172 patients without AF precipitants. Pneumonia/sepsis, myocardial infarction, respiratory failure, and cardiothoracic surgery were the most common precipitants identified. In multivariable analyses adjusting for age, sex, patient comorbidities, left atrial enlargement, left ventricular ejection fraction, and antiplatelet use, patients with AF precipitants were less likely to receive subsequent anticoagulation therapy at 30 days after the initial AF diagnosis (odds ratio, 0.31; 95% CI, 0.19-0.52). The association was persistent after excluding men with CHA2DS2-VASc score < 2 and women with CHA2DS2-VASc score < 3.


Our study highlights lower usage of oral anticoagulant in secondary AF in contemporary clinical practice.


anticoagulants, atrial fibrillation, ischemic stroke, UMCCTS funding

Rights and Permissions

© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

DOI of Published Version



Ko D, Saleeba C, Sadiq H, Crawford S, Paul T, Shi Q, Wang Z, Benjamin EJ, Walkey AJ, Lubitz SA, Kapoor A, McManus D. Secondary Precipitants of Atrial Fibrillation and Anticoagulation Therapy. J Am Heart Assoc. 2021 Nov 2;10(21):e021746. doi: 10.1161/JAHA.121.021746. Epub 2021 Oct 20. PMID: 34668392; PMCID: PMC8751824. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American Heart Association

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Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.