Electrophysiology
Recent trends in the incidence rates of and death rates from atrial fibrillation complicating initial acute myocardial infarction: A community-wide perspective*,**

https://doi.org/10.1067/mhj.2002.120410Get rights and content

Abstract

Background Limited information is available about recent trends in the incidence and death rates from atrial fibrillation (AF) complicating acute myocardial infarction (AMI). The purpose of this study was to examine the impact and trends over time of AF complicating initial AMI. Methods We conducted a longitudinal study of 2596 residents of the Worcester, Massachusetts, metropolitan area with initial AMI and without previous AF who were hospitalized at all area hospitals in 5 annual periods between 1990 and 1997. Results A total of 13% of hospitalized patients developed AF. There was a marked decrease in the proportion of patients who developed AF over time (18% in 1990; 11% in 1997). Patients hospitalized during the most recent study years remained at significantly lower risk for developing AF than patients hospitalized in 1990 after controlling for factors that might affect the risk of AF. Patients with AF were more likely to die during hospitalization than those without AF even after controlling for other prognostic factors. Despite the adverse impact of AF, we observed trends toward improved hospital survival during the most recent study years in patients developing AF. Patients discharged after developing AF had higher long-term death rates than patients who did not develop AF, although these differences were attenuated after adjusting for other factors. Conclusions The results of this community-wide study suggest a significant decline in the incidence of AF complicating AMI. Although patients with AF had higher hospital death rates, we observed trends of improved survival for these patients. AF remains a common complication of AMI to which targeted treatment efforts appear warranted. (Am Heart J 2002;143:519-27.)

Section snippets

Methods

We studied residents of the Worcester, Massachusetts, metropolitan area who were hospitalized with a primary or secondary discharge diagnosis of AMI (International Classification of Disease [ICD]-9 code 410) in all acute care general hospitals in the Worcester Standard Metropolitan Statistical Area; 1990 census records estimate a population of 437,000 during calendar years 1990, 1991, 1993, 1995, and 1997.18, 19, 20 Sixteen teaching and community hospitals were included in this study during its

Characteristics of patients with AF complicating initial AMI

The 343 patients with AMI who developed new onset AF were significantly older, more likely to be female, and more likely to have a history of hypertension compared with patients who did not develop AF (Table I).

. Characteristics of patients with initial acute myocardial infarction according to presence of atrial fibrillation: Worcester heart attack study

CharacteristicAF (present) (n = 343)AF (absent) (n = 2253)P
Age (mean, y)73.966.3<.001
Age (y) (%)
<557.621.8
55-6411.419.8<.001
65-742826.5
≥755331.9

Discussion

The results of this multi-hospital, community-wide study of 2596 residents of the Worcester metropolitan area hospitalized with initial AMI and without a medical history of AF suggest declines over time (1990-1997) in the incidence of new onset AF, higher hospital death rates among patients who developed AF, and encouraging improvements in the hospital survival of patients with AF from the earliest to most recent study years. Patients who developed AF during the index hospitalization had higher

Acknowledgements

We thank the cardiology, administration, and medical records departments at participating Worcester metropolitan area hospitals for making this project feasible.

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    *

    This project was supported through funding made available by the National Institutes of Health (RO1 HL35434).

    **

    Reprint requests: Robert J. Goldberg, PhD, Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. E-mail: [email protected].

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