Prognostic significance of newly diagnosed atrial fibrillation after acute myocardial infarction: A study of 184,980 medicare patients

Hakeem Ayinde, Benjamin Riedle, Amole Ojo, Ashraf Abugroun, Saket Girotra, Linnea Polgreen

Research output: Contribution to journalArticlepeer-review

Abstract

We aimed to determine whether newly diagnosed atrial fibrillation (AF) predicted cardiovascular events and death after myocardial infarction (AMI) in a large nationwide cohort of patients. All Medicare beneficiaries aged >65 years who were discharged alive after a diagnosis of AMI between January 1, 2007 and December 31, 2008 were identified. Main exposure was a diagnosis of AF during admission or within 90 days after discharge. Primary outcome was a composite of recurrent AMI, stroke and all-cause mortality. Secondary outcomes were each of recurrent AMI, stroke and all-cause mortality. We used Cox proportional hazards regression to assess the relationship between AF and time-to-event outcomes with follow up ending at 3 years. Of 184,980 patients, 9.1 % had AF; 40.6 % were male; 82.8 % were non-Hispanic whites. Mean age was 79.1 ± 8.1 years. Overall, 15.7 % had subsequent AMI, 5.7 % had stroke and 43.9 % died during a mean follow up of 26.4 months. AF was associated with a significantly increased risk of the primary outcome (Hazard ratio (HR) = 1.10; 95 % confidence interval (CI): 1.07–1.12). AF was also separately associated with significantly increased risk of recurrent AMI (HR = 1.09; 95 % CI: 1.04–1.14), stroke (HR = 1.29; 95 % CI: 1.21–1.37), and death (HR = 1.09; 95 % CI: 1.06–1.12). Neither age, race nor sex modified the effects of AF on primary or secondary outcomes. In conclusion, AF is a significant predictor of adverse cardiovascular outcomes and mortality after AMI. Further studies are needed to understand mechanisms by which AF alters outcomes in survivors of AMI.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Medicare
  • Mortality
  • Myocardial infarction
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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