Recent Trends In Oral Anticoagulant Use And Post-Discharge Complications Among Atrial Fibrillation Patients With Acute Myocardial Infarction
| Autor: | Nils Henninger, Mohammed Akhter, David D. McManus, Steven A. Lubitz, Amartya Kundu, Hong Yu, Daniel Z. Fisher, Darleen M. Lessard, Jorge L. Yarzebski, Joel M. Gore, Allan J. Walkey, Jane S. Saczynski, Kevin O Day, Alok Kapoor, Robert Hayward, Robert J. Goldberg |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Post discharge business.industry Atrial fibrillation 030204 cardiovascular system & hematology medicine.disease 03 medical and health sciences 0302 clinical medicine Stroke prevention Internal medicine Epidemiology medicine Cardiology Oral anticoagulant cardiovascular diseases 030212 general & internal medicine Myocardial infarction Cardiology and Cardiovascular Medicine Complication business Stroke Original Research |
| Zdroj: | Journal of Atrial Fibrillation. 10 |
| ISSN: | 1941-6911 |
| DOI: | 10.4022/jafib.1749 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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