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Published on: February 26, 2013
Recent Trends in Oral Anticoagulant Use and Post-Discharge Complications Among Atrial Fibrillation Patients with
Amartya Kundu1, Kevin O Day2, Darleen M Lessard3
1Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA.
Insights
Atrial fibrillation (AF) in acute myocardial infarction (AMI) survivors is common, especially in high-stroke-risk patients. Stroke prevention efforts need improvement, as many eligible patients do not receive oral anticoagulants.
Area of Science:
- Cardiology
- Stroke Prevention
- Epidemiology
Background:
- Atrial fibrillation (AF) is a frequent complication following acute myocardial infarction (AMI).
- Risk stratification scores like CHA2DS2-VASc guide oral anticoagulant (OAC) use in AF patients, including those with AMI.
- The epidemiology of AF and stroke risk stratification in AMI survivors is not well-characterized.
Purpose of the Study:
- To examine trends in AF occurrence among AMI survivors.
- To assess OAC discharge rates and post-discharge outcomes in AMI patients with AF.
- To stratify AF patients by stroke risk and analyze associated outcomes.
Main Methods:
- Retrospective analysis of 6,627 AMI survivors from 1997-2011 in the Worcester, MA area.
- Examined AF frequency, OAC discharge rates, and post-discharge complications.
- Stratified patients based on CHA2DS2-VASc scores to assess stroke risk.
Main Results:
- 16% of AMI survivors had AF, with 91% having a CHA2DS2-VASc score >2.
- AF patients in the highest stroke risk group had significantly higher 30-day and 1-year mortality and re-hospitalization rates.
- Less than half of guideline-eligible AF patients received OACs at discharge; statin and beta-blocker use also lagged compared to non-AF patients.
Conclusions:
- There is a critical need to improve stroke prevention strategies for AMI survivors with AF.
- Underutilization of OACs in high-risk AF patients requires attention.
- Enhanced evidence-based therapy use is necessary for this vulnerable population.
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.
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