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J Atr Fibrillation. 2018 Feb 28;10(5):1749. doi: 10.4022/jafib.1749. eCollection 2018 Feb.

Recent Trends in Oral Anticoagulant Use and Post-Discharge Complications Among Atrial Fibrillation Patients with Acute Myocardial Infarction.

Author information

1
Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA.
2
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
3
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
4
Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA.
5
Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
6
Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA, USA.
7
Department of Medicine, Boston University School of Medicine, Boston, MA.

Abstract

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, 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.

Conclusions:

Our findings highlight the need to enhance efforts towards stroke prevention among AMI survivors with AF.

KEYWORDS:

Anticoagulation; Atrial Fibrillation; Epidemiology; Outcomes

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