Trends Of Atrial Fibrillation Research Articles

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.

Trends in Atrial Fibrillation Complicating Acute Myocardial Infarction

Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) and this arrhythmia is associated with increased morbidity and mortality in patients with AMI. Limited information is available, however, about changing, and contemporary, trends in the incidence and death rates associated with AF complicating AMI. We examined the magnitude and impact of AF and the risk of stroke and hospital and long-term death rates in a population-based study of patients hospitalized with AMI. The study population consisted of 7,513 residents of the Worcester, Massachusetts, metropolitan area hospitalized with AMI at all greater Worcester medical centers during 9 biennial years from 1990 to 2005. Overall incidence of AF complicating AMI was 13.3% and rates of AF increased during the most recent years under study. Patients who developed AF were at greater risk for acute stroke (adjusted odds ratio 2.25, 95% confidence interval 1.36 to 3.71) and dying during hospitalization (adjusted odds ratio 1.79, 95% confidence interval 1.46 to 2.19) compared with patients who did not develop AF during hospitalization for AMI. Postdischarge survival was significantly poorer in patients who developed AF. Odds of dying after AF did not change appreciably over the years under study. In conclusion, results of this study in residents of a large New England metropolitan area suggest that AF remains a frequent complication of AMI and is associated with a poor prognosis. Increased surveillance and targeted therapeutic approaches appear warranted for these high-risk patients.

Clinical trends in atrial fibrillation at the turn of the millenium

Clinical trends in atrial fibrillation at the turn of the millenium