Abstract
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. 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. 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, fewerthan half of guideline-eligible AF patientsreceived an OACprescription at discharge. Usage rates for other evidence-based therapiessuch as statins and beta-blockers,lagged in comparison to AMI patients free from AF. Our findings highlight the need to enhance efforts towards stroke prevention among AMI survivors with AF.
Highlights
Atrial fibrillation (AF) is a cardiac arrhythmia that affects thousands of hospitalized Americans, with an increasing prevalence in the United States[1],[2]
Massachusetts, documenting long-term trends in the incidence, morbidity, mortality, and complications of acute myocardial infarction (AMI) . [7],[8],[1],[17] Our analyses focused on patients who were hospitalized with a discharge diagnosis of AMI at all Worcester Standard Metropolitan Statistical Area (SMSA) hospitals during 8 biennial years between 1997 and 2011
There are limited studies that have evaluated the prognostic utility of stroke risk classification schemes in predicting the risk of adverse outcomes in patients with concomitant AMI and AF.In a study of more than 15,000 patients admitted with AMI to hospitals in Korea, the investigators assessed the utility of CHA2DS2VASc scores in predicting the risk of dying and/or recurrent MI in patients with and without AF
Summary
Atrial fibrillation (AF) is a cardiac arrhythmia that affects thousands of hospitalized Americans, with an increasing prevalence in the United States[1],[2]. Atrial fibrillation is frequently observed as a complication of acute myocardial infarction (AMI), affecting 5-13% of all patients suffering an AMI[3]-[7]. The CHADS2 and CHA2DS2VASc scoring systems are used to stratify patients with AF at risk for developing stroke and identify patients who may benefit from oral anticoagulation (OAC), including patients with AMI[8],[11],[12]. antiplatelet drugs prevent thromboembolic complications in patients with AMI, . Observational studies have lent credibility to these concerns by showing an elevated bleeding risk among patients treated with dual antiplatelet agents and OAC[15]. Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI).The CHA2DS2VASc and CHADS2risk scores are used to identify patients with AF at risk for stroke and to guide oral anticoagulants (OAC) use, including patients with AMI. The epidemiology of AF, further stratified according to patients’ risk of stroke, has not been well characterized among those hospitalized for AMI
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