Coronary Artery Disease
Temporal Trends in the Occurrence and Outcomes of Atrial Fibrillation in Patients With Acute Myocardial Infarction (from the Atherosclerosis Risk in Communities Surveillance Study)

https://doi.org/10.1016/j.amjcard.2014.05.059Get rights and content

Atrial fibrillation (AF) frequently coexists in the setting of myocardial infarction (MI), being associated with increased mortality. Nonetheless, temporal trends in the occurrence of AF complicating MI and in the prognosis of these patients are not well described. We examined temporal trends in prevalence of AF in the setting of MI and the effect of AF on prognosis in the community. We studied a population-based sample of 20,049 validated first-incident nonfatal hospitalized MIs among 35- to 74-year old residents of 4 communities in the Atherosclerosis Risk in Communities (ARIC) Study from 1987 through 2009. Prevalence of AF in the setting of MI increased from 11% to 15% during the 23-year study period. The multivariable adjusted odds ratio for prevalent AF, per 5-year increment, was 1.11 (95% confidence interval 1.04 to 1.19). Overall, in patients with MI, AF was associated with increased 1-year case fatality (odds ratio 1.47, 95% confidence interval 1.07 to 2.01) compared with those without AF. However, there was no evidence that the impact of AF on MI survival changed over time or differed over time by sex, race, or MI classification (all p values >0.10). In conclusion, co-occurrence of AF in MI slightly increased between 1987 and 2009. The adverse impact of AF on survival in the setting of MI was consistent throughout. In the setting of MI, co-occurrence of AF should be viewed as a critical clinical event, and treatment needs unique to this population should be explored further.

Section snippets

Methods

The community surveillance component of the Atherosclerosis Risk in Communities (ARIC) Study, described previously, was designed to provide knowledge about the burden of and trends in coronary heart disease (CHD) morbidity and mortality in 4 US communities (details included in the Supplementary Material).9, 10

Presence of AF during the MI hospitalization was defined by the presence of AF International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), hospital

Results

Our final analytic sample included 13,155 definite and probable first-incident MIs, for a weighted sample of 20,049. Baseline patient characteristics over time, in 4-year intervals, are listed in Table 1, whereas Table 2 lists the prevalence of medications and therapeutic procedures. The age and sex distributions of the sample were stable over the study period, with an overall mean age of 59 years at the time of hospitalization; women accounted for 36% of the sample. The prevalence of AF

Discussion

In this population-based sample of validated MI hospitalizations, the prevalence of concomitant AF in MI increased slightly from 1987 to 2009 and was approximately 15% in the most recent years. The secular trend in the prevalence of AF in the setting of MI differed by MI classification; the prevalence of coexisting AF increased over time among NSTEMI and unclassified MIs and decreased among STEMIs. Co-occurrence of AF in the setting of MI was associated with an increased risk of death, and this

Disclosures

The authors have no conflicts of interest to disclose.

References (28)

  • P. Jabre et al.

    Atrial fibrillation and death after myocardial infarction: a community study

    Circulation

    (2011)
  • The atherosclerosis risk in communities (ARIC) study: design and objectives. The ARIC Investigators

    Am J Epidemiol

    (1989)
  • P.N. Jensen et al.

    A systematic review of validated methods for identifying atrial fibrillation using administrative data

    Pharmacoepidemiol Drug Saf

    (2012)
  • D.R. Jacobs et al.

    PREDICT: a simple risk score for clinical severity and long-term prognosis after hospitalization for acute myocardial infarction or unstable angina: the Minnesota Heart Survey

    Circulation

    (1999)
  • Cited by (0)

    The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C. This study additionally was supported by the National Heart, Lung, and Blood Institute grants RC1-HL-099452 and T32-HL-07779 (to Bengtson) and the American Heart Association grant 09SDG2280087.

    See page 696 for disclosure information.

    View full text