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. 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

Amartya Kundu  1 , Kevin O Day  2 , Darleen M Lessard  3 , Joel M Gore  1 , Steven A Lubitz  4 , Hong Yu  3 , Mohammed W Akhter  1 , Daniel Z Fisher  1 , Robert M Hayward Jr  1 , Nils Henninger  5 , Jane S Saczynski  6 , Allan J Walkey  7 , Alok Kapoor  2 , Jorge Yarzebski  3 , Robert J Goldberg  3 , David D McManus  1
Affiliations

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

Amartya Kundu et al. J Atr Fibrillation. .

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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Figures

Figure 1.
Figure 1.. Trends in the Rates of AFby CHA2DS2VASc Score between 1997 and 2011
Figure 2.
Figure 2.. Trends in the Rates of AF by CHADS2 Score between 1997 and 2011
Figure 3.
Figure 3.. One-Year Mortality (Odds Ratio with 95 % Confidence Intervals) among AMI Patients with AF stratified by CHA2DS2VASc scores, compared to AMI Patients without AF
See this image and copyright information in PMC

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