Trends Of Atrial Fibrillation Research Articles

Bibliometric Insights Into the Evolution of Atrial Fibrillation and Dementia Research 2002-2022.

BACKGROUND In response to the escalating prevalence of atrial fibrillation (AF) and its potential correlation with cognitive impairment and dementia, we conducted a comprehensive bibliometric analysis to assess current research trends, contributors, and collaborative networks in this evolving interdisciplinary field. MATERIAL AND METHODS Articles published between 2002 and 2022 were extracted from the Web of Science database and carefully screened, yielding 328 publications. Two reviewers independently conducted the screening and quality appraisal. We employed sophisticated tools such as CiteSpace, VOSviewer, and Bibliometrix (R-Studio's R tool) to succinctly summarize and thoroughly analyze the publications. RESULTS A total of 328 publications, comprising 262 papers and 66 reviews, were included in the final analysis. The number of publications exhibited a consistent year-on-year increase, demonstrating an average annual growth rate of 20.57%. These publications originated from 41 countries and regions, with the highest contributions observed from the United States, United Kingdom, Italy, and China. Notably, the University of Liverpool emerged as the most prolific institution, while the most prolific author was Lip GYH from the United Kingdom. The journal with the most publications is the journal of the American Heart Association (19 articles). The most popular keywords in order were: risk and stroke (n=101), dementia (n=100), decline (n=70), prevalence (n=67), and Alzheimer's disease. CONCLUSIONS This study shows the current research status and emerging trends in atrial fibrillation's link to dementia and cognitive impairment. It highlights global growth and collaboration patterns while offering a comprehensive view of their interrelationship, pointing toward future research directions.

Sex-specific time trends in incident atrial fibrillation and the contribution of risk factors: the Tromsø Study 1994-2016.

To explore sex-specific time trends in atrial fibrillation (AF) incidence and to estimate the impact of changes in risk factor levels using individual participant-level data from the population-based Tromsø Study 1994-2016. A total of 14 818 women and 13 225 men aged 25 years or older without AF were enrolled in the Tromsø Study between 1994 and 2008 and followed up for incident AF throughout 2016. Poisson regression was used for statistical analyses. During follow-up, age-adjusted AF incidence rates in women decreased from 1.19 to 0.71 per 1000 person-years. In men, AF incidence increased from 1.18 to 2.82 per 1000 person-years in 2004, and then declined to 1.94 per 1000 person-years in 2016. Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), physical activity, smoking and alcohol consumption together accounted for 10.9% [95% confidence interval (CI): -2.4 to 28.6] of the AF incidence decline in women and for 44.7% (95% CI: 19.2; 100.0) of the AF incidence increase in men. Reduction in SBP and DBP had the largest contribution to the decrease in AF incidence in women. Increase in BMI had the largest contribution to the increase in AF incidence in men. In the population-based Tromsø Study 1994-2016, AF incidence decreased in women and increased following a reverse U-shape in men. Individual changes in SBP and DBP in women and individual changes in BMI in men were the most important risk factors contributing to the AF incidence trends.

Anticoagulation for atrial fibrillation in people with serious mental illness in the general hospital setting

ObjectivePeople with serious mental illnesses (SMI) have an increased risk of stroke compared to the general population. This study aims to evaluate oral anticoagulation prescription trends in atrial fibrillation (AF) patients with and without a comorbid SMI. MethodsAn open-source retrieval system for clinical data (CogStack) was used to identify a cohort of AF patients with SMI who ever had an inpatient admission to King's College Hospital from 2011 to 2020. A Natural Language Processing pipeline was used to calculate CHA2DS2-VASc and HASBLED risk scores from Electronic Health Records free text. Antithrombotic prescriptions of warfarin and Direct acting oral anti-coagulants (DOACs) (apixaban, rivaroxaban, dabigatran, edoxaban) were extracted from discharge summaries. ResultsAmong patients included in the study (n = 16 916), 2.7% had a recorded co-morbid SMI diagnosis. Compared to non-SMI patients, those with SMI had significantly higher CHA2DS2-VASc (mean (SD): 5.3 (1.96) vs 4.7 (2.08), p < 0.001) and HASBLED scores (mean (SD): 3.2 (1.27) vs 2.5 (1.29), p < 0.001). Among AF patients having a CHA2DS2-VASc ≥2, those with co-morbid SMI were less likely than non-SMI patients to be prescribed an OAC (44% vs 54%, p < 0.001). However, there was no evidence of a significant difference between the two groups since 2019. ConclusionOver recent years, DOAC prescription rates have increased among AF patients with SMI in acute hospitals. More research is needed to confirm whether the introduction of DOACs has reduced OAC treatment gaps in people with serious mental illness and to assess whether the use of DOACs has improved health outcomes in this population.

Atrial Fibrillation and Dementia: Epidemiological Insights on an Undervalued Association

Background and objectives: Atrial fibrillation (AF) and dementia are growing causes of morbidity and mortality, representing relevant medical and socioeconomic burdens. In this study, based on data from the Global Burden of Disease Injuries and Risk Factors Study (GBD) 2019, we focused on AF and dementia distribution and investigated the potential correlation between the two epidemiological trends. Materials and Methods: Crude and age-standardized incidence, prevalence, mortality rate, and disability-adjusted life years (DALYs) lost, derived from GBD 2019, were reported for AF and dementia. Global features were also stratified by high and low sociodemographic-index (SDI) countries. Granger test analysis was performed to investigate the correlation between AF and dementia incidence time trends. Results: From 1990 to 2019 crude worldwide incidence and prevalence showed a dramatic increase for both conditions (from 43.24 to 61.01 and from 528.72 to 771.51 per 100,000 individuals for AF, respectively; from 54.60 to 93.52 and from 369.88 to 667.2 per 100,000 individuals for dementia, respectively). In the same timeframe, crude mortality rate doubled for AF and dementia (from 2.19 to 4.08, and from 10.49 to 20.98 per 100,000 individuals, respectively). Age-standardized estimate showed a substantial stability over the years, highlighting the key role of the progressively aging population. Crude estimates of all of the investigated metrics are greater in high SDI countries for both conditions. This association was still valid for age-standardized metrics, albeit by a reduced magnitude, suggesting the presence of higher risk factor burden in these countries. Finally, according to Granger test, we found a significant association between the historical trends of AF and dementia incidence (p = 0.004). Conclusions: AF and dementia burden progressively increased in the last three decades. Given the potential association between these two conditions, further clinical data assessing this relationship is needed.

Abstract 10894: Socioeconomic Status and Differences in Trends of Atrial Fibrillation In-Hospital Mortality Among Black and Non-Black Adults in the United States

Introduction: Race and socioeconomic status (SES) is interconnected. There is scarce data analyzing trends of atrial fibrillation (AF) in-hospital mortality in black and non-black adults based on SES. Methods: We queried the National Inpatient Sample database from January 2004 to December 2018 to identify patients admitted with AF. We used ICD-9-CM and ICD-10-CM diagnosis codes to identify all patients who were 18 years of age or older and hospitalized with a primary discharge diagnosis of Atrial Fibrillation. Our cohort was further categorized by race, into black and non-black groups, and socioeconomic status (SES) using median household income (MHI) as a surrogate, into low SES (MHI 0-50) and high SES (MHI 51-100). We excluded all patients with incomplete data on age, gender, race, MHI and in-hospital mortality status. Also, in order to reduce the possibility of data duplication, the patients with an indicator for transfer to another acute-care facility were excluded. Cochran-Armitage Test was utilized to estimate temporal trends. Results: Black and non-black adults have had improvement of in-hospital mortality, although black adults still have higher trends as compared to non-black counterparts (p&lt;0.001). Conclusions: Trends of AF in-hospital mortality between black and non-black individuals are comparable despite a significantly smaller proportion of blacks in our study. There is a dynamic interplay among social and health risk factors associated with AF in black individuals and further studies are required to better understand this relation.

Abstract 10354: Socioeconomic Status and Differences in Trends of Atrial Fibrillation Hospitalizations Among Black and Non-Black Adults in the United States

Introduction: Socioeconomic status (SES) and race is closely interlinked. There is limited data regarding trends of atrial fibrillation (AF) hospitalizations in black and non-black adults based on SES. Methods: We queried the National Inpatient Sample database from January 2004 to December 2018 to identify patients admitted with AF. We used ICD-9-CM and ICD-10-CM diagnosis codes to identify all patients who were ≥18 years of age and hospitalized with a primary discharge diagnosis of AF. Our cohort was categorized into black and non-black groups, and SES using median household income (MHI) as a surrogate, into low SES (MHI 0-50) and high SES (MHI 51-100). AF hospitalizations per 1 million US population were calculated using US census population ≥18 years of age for each year. We estimated AF hospitalizations per 1 million blacks and non-blacks and trends in AF hospitalizations of black and non-black adults stratified by SES utilizing MHI. Cochran Armitage Test was utilized to estimate temporal trends. Results: Total admissions for AF per 1 million adults in the US population has increased (Figure 1). Among patients hospitalized with AF, the proportion of black adults is increasing. In those of low SES, both black and non-black patients have had increases in AF hospitalizations. However, in those of high SES, non-black patients have had steady improvement while black patients have remained at about the same rate of hospitalizations from 2004 to 2018 (Figure 2). Conclusions: Trends of AF hospitalizations have increased or not improved in low and high MHI-SES black adults, respectively. Identifying causes of these health disparities can improve healthcare quality in black adults with AF.

National Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure.

BackgroundHeart failure (HF) and atrial fibrillation (AF) frequently coexist and may be associated with worse HF outcomes, but there is limited contemporary evidence describing their combined prevalence. We examined current trends in AF among hospitalizations for HF with preserved (HFpEF) ejection fraction or HF with reduced ejection fraction (HFrEF) in the United States, including outcomes and costs.Methods and ResultsUsing the National Inpatient Sample, we identified 10 392 189 hospitalizations for HF between 2008 and 2017, including 4 250 698 with comorbid AF (40.9%). HF hospitalizations with AF involved patients who were older (average age, 76.9 versus 68.8 years) and more likely White individuals (77.8% versus 59.1%; P<0.001 for both). HF with preserved ejection fraction hospitalizations had more comorbid AF than HF with reduced ejection fraction (44.9% versus 40.8%). Over time, the proportion of comorbid AF increased from 35.4% in 2008 to 45.4% in 2017, and patients were younger, more commonly men, and Black or Hispanic individuals. Comorbid hypertension, diabetes mellitus, and vascular disease all increased over time. HF hospitalizations with AF had higher in‐hospital mortality than those without AF (3.6% versus 2.6%); mortality decreased over time for all HF (from 3.6% to 3.4%) but increased for HF with reduced ejection fraction (from 3.0% to 3.7%; P<0.001 for all). Median hospital charges were higher for HF admissions with AF and increased 40% over time (from $22 204 to $31 145; P<0.001).ConclusionsAF is increasingly common among hospitalizations for HF and is associated with higher costs and in‐hospital mortality. Over time, patients with HF and AF were younger, less likely to be White individuals, and had more comorbidities; in‐hospital mortality decreased. Future research will need to address unique aspects of changing patient demographics and rising costs.

Paradoxical impact of socioeconomic factors on outcome of atrial fibrillation in Europe: trends in incidence and mortality from atrial fibrillation.

The aim of this study was to understand the changing trends in atrial fibrillation (AF) incidence and mortality across Europe from 1990 to 2017, and how socioeconomic factors and sex differences play a role. We performed a temporal analysis of data from the 2017 Global Burden of Disease Database for 20 countries across Europe using Joinpoint regression analysis. Age-adjusted incidence, mortality, and mortality-to-incidence ratios (MIRs) to approximate case fatality rate are presented. Incidence and mortality trends were heterogenous throughout Europe, with Austria, Denmark, and Sweden experiencing peaks in incidence in the middle of the study period. Mortality rates were higher in wealthier countries with the highest being Sweden for both men and women (8.83 and 8.88 per 100000, respectively) in 2017. MIRs were higher in women in all countries studied, with the disparity increasing the most over time in Germany (43.6% higher in women vs. men in 1990 to 74.5% higher in women in 2017). AF incidence and mortality across Europe did not show a general trend, but unique patterns for some nations were observed. Higher mortality rates were observed in wealthier countries, potentially secondary to a survivor effect where patients survive long enough to suffer from AF and its complications. Outcomes for women with AF were worse than men, represented by higher MIRs. This suggests that there is widespread healthcare inequality between the sexes across Europe, or that there are biological differences between them in terms of their risk of adverse outcomes from AF.

Impact of prescription patterns of antithrombotic treatment on atrial fibrillation-related ischemic stroke

Objective To analyze the temporal trends of atrial fibrillation (AF)-related ischemic stroke (IS) and their relationship with the prescription patterns of antithrombotic treatment from 2013 to 2019 in the Health Assistance Area of a regional hospital. Methods First, a retrospective ecological study of aggregate data to analyze the annual incidence of IS between 2013 and 2019 was performed. Second, we selected those patients diagnosed with AF between 2013 and 2019 and performed a retrospective longitudinal study to assess the role of antithrombotic therapy in the development of AF-related IS. Results During this period, whereas the annual incidence of IS remained stable (from 1.3 in 2013 to 1.2 cases per 1000 inhabitants in 2019; adjusted P for trend .829), the annual incidence of AF-related IS decreased over time (from 23.8 to 18.8 cases per 1000 inhabitants, respectively; adjusted P for trend .001). Among AF patients, the use of direct oral anticoagulants increased from 5.5% to 46.8%, while the prescription of antiplatelets and vitamin K antagonists decreased from 21.9% to 6.0% and from 63.8% to 36.1%, respectively. Overall, the use of oral anticoagulants increased from 69.3% to 82.9%; p < .001. Patients under antiplatelet agents had a higher probability of presenting IS than those patients taking oral anticoagulants, either vitamin K antagonists or direct oral anticoagulants (adjusted OR 1.89; 95% CI 1.52–2.37; p < .001). Conclusions The prescription of oral anticoagulants, particularly direct oral anticoagulants, has increased from 2013 to 2019 in our Health Assistance Area. This increase might partially explain the reduction in AF-related IS.

Longitudinal study of adherence to anticoagulation guidelines in patients with atrial fibrillation

Abstract Introduction Anticoagulation (AC) reduces the risk of stroke and systemic embolism (SSE) in patients with Atrial Fibrillation (AF). However, the association between changes in AF prevalence, risk factors for SSE, uptake of AC and incidence of SSE has not been documented specifically in these patients within a national population. Purpose Identifying antithrombotic prescribing and evaluating associations between changes in AF prevalence, SSE risk factors (CHA2DS2-VASC score) and uptake of AC. Evaluating relationships between changes in proportion of AF patients treated with AC and SSE rate at a population level. Developing a modelling tool which estimates rates of SSE (past and future) based on these factors, which can be used to drive improvements in health care. Method AF patients were identified in the population of Wales (SAIL databank) between 2012–2018. Temporal trends of AF, CHA2DS2-VASC scores, anti-thrombotic prescriptions and SSE events were evaluated. Multi-state Markov models were used to estimate SSE rates adjusted for AC and CHA2DS2-VASC scores. Simulation methods modelled SSE outcomes for the subsequent 7-years based on differing proportional population AC coverage. Results AF prevalence increased from 51,492 to 64,852 from 2012–18, with mean CHA2DS2-VASC score increasing from 3.0 to 3.9. AC prescription coverage increased (24,892 [48.3%] to 44,195 [68.1%]), whilst antiplatelet therapy alone or no antithrombotic therapy decreased (14,532 [28.0%] to 5,385 [8.3%] and 26,602 [52.0%] to 21,164 [33.0%] respectively). Hospitalisation rate for SSE in AF population decreased by over 20%, from 1,039 per 100,000 patients/quarter in 2012 to 809 per 100,000 patients/quarter in 2018. Markov modelling demonstrated a 39% lower SSE rate with AC compared to no AC over time, after adjustment for individual CHA2DS2-VASC (HR=0.61, 95% CI [0.58, 0.63]). Using the estimated progression rates, simulation models shown that an expected 3,574 SSE events per 100,000 per year could have been reduced to 2,956 (17% reduction rate) if AC adherence had been at the now recommended 90% rate from 2012. This model also predicts that improving AC coverage to 90% of patients over the next 7-years would reduce SSE rates by 12% per year (assuming no further increase in mean CHA2DS2-VASC score). Conclusion Despite the increase in both prevalence of AF and CHA2DS2-VASC between 2012–18, we observed a progressive decrease in SSE events along with increasing AC prescribing. Our study suggests not only that improved AC coverage is associated with better clinical outcomes, but also that the rate of therapeutic implementation is likely a crucial factor. Reducing transition time between evidence-based guideline publication and widespread clinical uptake of the recommendations appears to be an important opportunity to improve clinical outcomes at a population level and should inform healthcare policy development and implementation. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Funded by research grant

Comparison of Frequency of Atrial Fibrillation in Blacks Versus Whites and the Utilization of Race in a Novel Risk Score

Blacks have a lower prevalence of atrial fibrillation (AF) compared with Whites. We sought to confirm previously reported ethnic trends in AF in Blacks and Whites in a large database, and develop a prediction score for AF. Over 330 million hospital discharges between the years 2003 to 2013 from the National Inpatient Sample database were analyzed. All hospitalizations with a diagnosis of AF formed the study cohort. Traditional risk factors for the development of AF were compared between Blacks and Whites. Univariate and multiple logistic regression analyses were used to formulate a risk score to predict AF-CHADSAVES (Congestive heart failure, Hypertension, Age>65 years, Diabetes Mellitus, prior Stroke, Age>75 years, Vascular disease, White Ethnicity, and previous cardiothoracic Surgery). AF prevalence in Whites was 11.3% vs 4.6% in Blacks (p < 0.001). Blacks were younger (33.8% vs 14.4% patients <65 years, p < 0.01) and had less males (46.3% vs 49.4%, p < 0.01). Blacks had more hypertension (71.3% vs 64.1%, p < 0.01), congestive heart failure (24.8% vs 22.6%, p < 0.01), diabetes mellitus with (7.5% vs 4.7%, p < 0.01) or without complications (30.3% vs 23.1%, p < 0.01), renal failure (29.7% vs 17.1%, p < 0.01), and obesity (13.1% vs 8.7%, p < 0.01). CHADSAVES predicted AF in the study population (NIS 2003 to 2013) with an AUC of 0.82 and verified in a validation cohort (NIS 2014) with an AUC of 0.85. In conclusion, our data confirm a significant AF ethnicity paradox. Despite a higher prevalence of traditional risk factors for AF, Blacks had >2-fold lower prevalence of AF compared with Whites. CHADSAVES can be used effectively to predict AF in inpatients.

P934Temporal trends in risk of atrial fibrillation and stroke in patients with peripheral artery disease between 1997 to 2015

Abstract Objectives The risk of atrial fibrillation (AF) and stroke in patients with peripheral artery disease (PAD) is an important and inadequately addressed issue. Our aim was to examine temporal trends in the incidence of AF and stroke in patients with PAD. Methods Danish nationwide registers were used to identify all patients aged ≥18 years, with first-time diagnosis of PAD between 1997 and 2015. Age-standardized incidence rates per 1.000 person-years were calculated to estimate trends of AF and stroke. Risk of AF and stroke was furthermore estimated by 1-year cumulative-incidence divided into four year-groups. Results A total of 121.211 patients with first-time diagnosis of PAD were included. The 1-year cumulative-incidence of AF in patients with PAD were 1.97% for year 1997–2000, 2.63% for year 2001–2005, 2.66% for year 2006–2010, and 2.78% for year 2011–2015, respectively. The 1-year cumulative-incidence of stroke in patients with PAD were 2.71%, 2.71%, 1.95%, and 1.81%, for the 1997–2000, 2001–2005, 2006–2010, and 2011–2015 year-groups respectively. Likewise, the age-standardized incidence rates showed increasing trends of AF during the study period whereas trends of stroke demonstrated a decline (Figure 1). All age-standardized trends were statistically significant (p&lt;0.05). During the course of study i.e., between 1997 and 2015, the initiation of cholesterol-lowering agents, clopidogrel, and oral anticoagulants increased markedly from 7.0% to 51.3%, 0.1% to 5.9%, and 0.0% to 0.7%, respectively. Figure 1 Conclusion The incidence of AF in patients with PAD has significantly increased over time whereas a marked decline has occurred in the incidence of stroke. This suggests that the secondary prevention strategies aimed at reducing risk of stroke are broadly effective. Moreover, due to global aging, earlier and more frequent diagnosis, and improved treatment of cardiovascular risk factors may explain the increasing incidence of AF.

Utilization of Anticoagulation and Antiplatelet Therapies in Patients with Atrial Fibrillation and Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Utilization of Anticoagulation and Antiplatelet Therapies in Patients with Atrial Fibrillation and Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Increasing atrial fibrillation prevalence in acute ischemic stroke and TIA.

To evaluate trends in atrial fibrillation (AF) prevalence in acute ischemic stroke (AIS) and TIA in the United States. We used the Nationwide Inpatient Sample to retrospectively compute weighted prevalence of AF in AIS (n = 4,355,140) and TIA (n = 1,816,459) patients admitted to US hospitals from 2004 to 2013. Multivariate-adjusted models were used to evaluate the association of AF with clinical factors, mortality, length of stay, and cost. From 2004 to 2013, AF prevalence increased by 22% in AIS (20%-24%) and by 38% in TIA (12%-17%). AF prevalence varied by age (AIS: 6% in 50-59 vs 37% in ≥80 years; TIA: 4% in 50-59 vs 24% in ≥80 years), sex (AIS: male 19% vs female 25%; TIA: male 15% vs female 14%), race (AIS: white 26% vs black 12%), and region (AIS: Northeast 25% vs South 20%). Advancing age, female sex, white race, high income, and large hospital size were associated with increased odds of AF in AIS. AF in AIS was a risk factor for in-hospital death (odds ratio 1.93, 95% confidence interval 1.89-1.98) but mortality in AIS with AF decreased from 11.6% to 8.3% (p < 0.001). Compared to no AF, AF was associated with increased cost of $2,310 and length of stay 1.1 days in AIS. AF prevalence in AIS and TIA has continued to increase. Disparity in AF prevalence in AIS and TIA exists by patient and hospital factors. AF is associated with increased mortality in AIS. Innovative AIS preventive strategies are needed in patients with AF, especially in the elderly.

30-year nationwide trends in incidence of atrial fibrillation in Denmark and associated 5-year risk of heart failure, stroke, and death

BackgroundLong-term nationwide trends in atrial fibrillation (AF) incidence and 5-year outcomes are rare. MethodsWe conducted a population-based cohort study using the Danish National Patient Registry covering all Danish hospitals. We computed standardized incidence rates during 1983–2012. We used Cox regression to estimate hazard ratios (HRs) of heart failure, stroke, and death within 5years, comparing 5-year calendar periods with the earliest period (1983–1987) as reference. ResultsWe identified 312,420 patients with first-time hospital-diagnosed AF. The incidence rate per 100,000person-years increased from 98 in 1983 to 307 in 2012. The mean annual increase during the 30-year study period was 4%, with a 6% increase annually until 2000 and a 1.4% increase annually thereafter. The incidence trends were most pronounced among men and persons above 70years. Among high-risk subgroups, AF incidence was consistently highest in patients with valvular heart disease or heart failure. The rate of heart failure following AF declined by 50% over the entire study period (HR: 0.49, 95% confidence interval (CI): 0.48–0.51) and the mortality rate declined by 40% (HR: 0.62, 95% CI: 0.61–0.63). Within the last two decades, the rate for ischemic stroke declined by 20% (HR 0.81, 95% CI: 0.78–0.84), but increased almost as much for haemorrhagic stroke (HR: 1.14, 95% CI: 1.01–1.29). ConclusionsThe long-term risk of heart failure, ischemic stroke, and death following onset of AF has decreased remarkably over the last three decades. Still, the threefold increased incidence of hospital-diagnosed AF during the same period is a major public health concern.

Relation of Atrial Fibrillation in Acute Myocardial Infarction to In-Hospital Complications and Early Hospital Readmission

Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) and contributes to high rates of in-hospital adverse events. However, there are few contemporary studies examining rates of AF in the contemporary era of AMI or the impact of new-onset AF on key in-hospital and postdischarge outcomes. We examined trends in AF in 6,384 residents of Worcester, Massachusetts, who were hospitalized with confirmed AMI during 7 biennial periods between 1999 and 2011. Multivariate logistic regression analysis was used to examine associations between occurrence of AF and various in-hospital and postdischarge complications. The overall incidence of AF complicating AMI was 10.8%. Rates of new-onset AF increased from 1999 to 2003 (9.8% to 13.2%), and decreased thereafter. In multivariable adjusted models, patients developing new-onset AF after AMI were at a higher risk for in-hospital stroke (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.6 to 4.1), heart failure (OR 2.0, 95% CI 1.7 to 2.4), cardiogenic shock (OR 3.7, 95% CI 2.8 to 4.9), and death (OR 2.3, 95% CI 1.9 to 3.0) than patients without AF. Development of AF during hospitalization for AMI was associated with higher rates of readmission within 30 days after discharge (21.7% vs 16.0%), but no significant difference was noted in earlypostdischarge 30-day all-cause mortality rates (8.3% vs 5.1%). In conclusion, new-onset AF after AMI is strongly related to in-hospital complications of AMI and higher short-term readmission rates.

Abstract 15163: Recent Trends in Atrial Fibrillation and Short Term Outcomes Following Acute Myocardial Infarction : A Population Based Perspective

Introduction: Atrial Fibrillation (AF) is a common complication during hospitalization for acute myocardial infarction (AMI) and is associated with increased morbidity and mortality in patients with AMI.However, there is limited information on contemporary trends in the incidence of AF in patients admitted with AMI and its impact on clinically relevant in-hospital and post-discharge outcomes. Methods: We examined trends in AF complicating AMI using data from the Worcester Heart Attack Study. The study population consisted of 6384 residents of Worcester, Massachusetts hospitalized with AMI for 7 biennial years from 1999 to 2011. Data was abstracted through the review of hospital medical records. Multivariate logistic regression analysis was used to examine the association between occurrence of AF and various in-hospital complications. Results: Overall incidence of AF complicating AMI was 10.8 %. The rate increased in the first half of the study period from 1999 to 2003 and declined thereafter .In models adjusting for other factors associated with adverse outcomes following AMI, we noted that compared to patients who did not develop AF, those who developed AF following AMI were at a higher risk of developing stroke [OR 2.53, 95 % CI 1.56 to 4.13], heart failure [OR 1.56, 95 % CI 1.31 to 1.87], and cardiogenic shock [OR 3.72, 95 % CI 2.82 to 4.90]. All-cause mortality during hospitalization was higher in those who developed AF[ OR 2.34, 95 % CI 1.87 to 2.94 ]; as was 30 day post discharge mortality [OR 1.29, 95 % CI 0.90 to 1.86] and 30 day post discharge readmission rate [OR 1.37, 95 % CI 1.09 to 1.72]. Conclusion: Our findings show that despite advancements in the treatment of AMI and reduced in-hospital mortality over the last 2 decades, new-onset AF remains common and related to multiple in-hospital and post-discharge adverse outcomes. Increased in-hospital monitoring and short-term post-discharge surveillance appears warranted for patients who develop AF in the context of AMI.

Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation-Related Stroke: A Population Study.

Demographic trends in atrial fibrillation (AF) incidence may yield a substantial rise in the societal burden of AF-related stroke (AF-stroke). Accurate population-wide outcome data are essential to inform health service planning to improve AF-stroke prevention, and provision of rehabilitation, nursing home, and community supports for AF-stroke survivors. We investigated rates and determinants of 5-year fatality, stroke recurrence, functional outcomes, and prescribing of secondary prevention medications in AF-stroke in the North Dublin Population Stroke Study. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using lifetables and Kaplan-Meier survival curves, and Cox proportional hazard modeling was performed to identify predictors of death and recurrent stroke. Five hundred sixty-eight patients with new stroke were identified, including 177 (31.2%) AF-stroke. At 5 years, 39.2% (confidence interval, 31.5-46.8) of ischemic AF-stroke patients were alive. Congestive heart failure, hypertension, age <65, 65-74 years, and ≥75 years, diabetes mellitus, prior stroke, transient ischemic attack or thromboembolism, vascular disease and female sex (CHA2DS2-VASc) score (hazard ratio [HR], 1.34; P<0.001), CHADS2 score (HR 1.42, P=0.004), National Institute of Health Stroke Scale (HR, 1.09; P<0.0001), and subtherapeutic international normalized ratio (<2.0) at stroke onset (HR, 3.29; P=0.003) were independently associated with 5-year fatality, whereas warfarin (HR, 0.40; P=0.001) and statin use after index stroke (HR, 0.52; P=0.005) were associated with improved survival. The 5-year recurrence rate after ischemic AF-stroke was 21.5% (confidence interval, 14.5-31.3). Trends toward greater risk of recurrence were observed for persistent AF (HR, 3.09; P=0.07) and CHA2DS2-VASc score (HR, 1.34; P=0.07). Nursing home care was needed for 25.9% of patients. AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed.

Trends in Atrial Fibrillation in Patients Hospitalized with an Acute Coronary Syndrome

BackgroundAtrial fibrillation is common among patients with cardiovascular disease and is a frequent complication of the acute coronary syndrome. Data are needed on recent trends in the magnitude, clinical features, treatment, and prognostic impact of preexisting and new-onset atrial fibrillation in patients hospitalized with an acute coronary syndrome. MethodsThe study population consisted of 59,032 patients hospitalized with an acute coronary syndrome at 113 sites in the Global Registry of Acute Coronary Events Study between 2000 and 2007. ResultsA total of 4494 participants (7.6%) with acute coronary syndrome reported a history of atrial fibrillation and 3112 participants (5.3%) developed new-onset atrial fibrillation during their hospitalization. Rates of new-onset atrial fibrillation (5.5%-4.5%) and preexisting atrial fibrillation (7.4%-6.7%) declined during the study. Preexisting atrial fibrillation was associated with older age and greater cardiovascular disease burden, whereas new-onset atrial fibrillation was closely related to the severity of the index acute coronary syndrome. Patients with atrial fibrillation were less likely than patients without atrial fibrillation to receive evidence-based therapies and more likely to develop in-hospital complications, including heart failure. Overall hospital death rates in patients with new-onset and preexisting atrial fibrillation were 14.5% and 8.9%, respectively, compared with 1.2% in those without atrial fibrillation. Short-term death rates in patients with atrial fibrillation declined over the study period. ConclusionsDespite a reduction in the rates of, and mortality from, atrial fibrillation, this arrhythmia exerts a significant adverse effect on survival among patients hospitalized with an acute coronary syndrome. Opportunities exist to improve the identification and treatment of patients with acute coronary syndrome with, or at risk for, atrial fibrillation to reduce the incidence and resultant complications of this dysrhythmia.

Differences and time trends in drug treatment of atrial fibrillation in men and women and doctors’ adherence to warfarin therapy recommendations

Little is known about prescription trends in atrial fibrillation (AF) in primary health care in Sweden. The aim was to study time trends in pharmacotherapy, in men and women with AF. We also aimed at studying doctors' adherence to CHADS2 for prescribing warfarin. CHADS2 assesses stroke risk by presence of known risk factors, i.e., congestive heart failure, hypertension, age >75 years, diabetes, previous stroke and transient ischemic attack. Data were obtained from primary health care records that contained individual clinical data. In total, 371,036 patients were included in the sample from 2002, and 424,329 patients were included in the sample from 2007. The study population consisted of individuals aged 45+ years who were diagnosed with AF in 2002 (1,330 men and 1,096 women) and 2007 (2,748 men and 2,234 women). The pharmacotherapies prescribed in 2002 and 2007 were analyzed separately in men and women. Logistic regression was used to calculate the association between the CHADS2 score and prescribed warfarin treatment. Selective beta-blockers, anti-coagulant therapy and lipid-lowering drugs were prescribed more frequently in 2007 than in 2002. In 2007, antithrombotic and RAS-blocking agents were prescribed more frequently to men, whereas beta-1 selective beta-blockers were prescribed more frequently to women. There was no consistent association between the CHADS2 score and prescribed warfarin treatment. Pharmacotherapy of AF has improved over time, though CHADS2 guidelines need to be implemented systematically in primary health care in Sweden to decrease the risk of stroke and improve quality of life in patients with AF.