Abstract 15163: Recent Trends in Atrial Fibrillation and Short Term Outcomes Following Acute Myocardial Infarction : A Population Based Perspective

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Amartya Kundu ◽  
Amir Shaikh ◽  
Darleen Lessard ◽  
Jane Saczynski ◽  
Jorge Yarzebski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Multivariate Logistic Regression Analysis ◽  
Population Based ◽  
Adverse Outcomes ◽  
Limited Information ◽  
Short Term ◽  
Post Discharge ◽  
Using Data

Introduction: Atrial Fibrillation (AF) is a common complication during hospitalization for acute myocardial infarction (AMI) and is associated with increased morbidity and mortality in patients with AMI.However, there is limited information on contemporary trends in the incidence of AF in patients admitted with AMI and its impact on clinically relevant in-hospital and post-discharge outcomes. Methods: We examined trends in AF complicating AMI using data from the Worcester Heart Attack Study. The study population consisted of 6384 residents of Worcester, Massachusetts hospitalized with AMI for 7 biennial years from 1999 to 2011. Data was abstracted through the review of hospital medical records. Multivariate logistic regression analysis was used to examine the association between occurrence of AF and various in-hospital complications. Results: Overall incidence of AF complicating AMI was 10.8 %. The rate increased in the first half of the study period from 1999 to 2003 and declined thereafter .In models adjusting for other factors associated with adverse outcomes following AMI, we noted that compared to patients who did not develop AF, those who developed AF following AMI were at a higher risk of developing stroke [OR 2.53, 95 % CI 1.56 to 4.13], heart failure [OR 1.56, 95 % CI 1.31 to 1.87], and cardiogenic shock [OR 3.72, 95 % CI 2.82 to 4.90]. All-cause mortality during hospitalization was higher in those who developed AF[ OR 2.34, 95 % CI 1.87 to 2.94 ]; as was 30 day post discharge mortality [OR 1.29, 95 % CI 0.90 to 1.86] and 30 day post discharge readmission rate [OR 1.37, 95 % CI 1.09 to 1.72]. Conclusion: Our findings show that despite advancements in the treatment of AMI and reduced in-hospital mortality over the last 2 decades, new-onset AF remains common and related to multiple in-hospital and post-discharge adverse outcomes. Increased in-hospital monitoring and short-term post-discharge surveillance appears warranted for patients who develop AF in the context of AMI.

Abstract P208: Functional Status, Rehospitalization, and Mortality Outcomes Among Acute Myocardial Infarction Patients with Prior and New-Onset Atrial Fibrillation

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Kyle P Hornsby ◽  
Kensey Gosch ◽  
Amy L Miller ◽  
Jonathan P Piccini ◽  
Renato D Lopes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Health Status ◽  
Functional Status ◽  
Physical Function ◽  
Adverse Outcomes ◽  
Increased Risk ◽  
New Onset

Background: Little data are available regarding differences in prognosis and health status between new-onset and prior atrial fibrillation (AF) among patients with acute myocardial infarction (AMI). Methods: The TRIUMPH study enrolled 4340 AMI patients who received longitudinal follow-up including SF-12 health status assessments through 1 year post-AMI. We compared 1-year mortality, rehospitalization, and functional status according to AF type (none, prior, new) after adjusting for differences in baseline characteristics. Results: A total of 212 AMI patients (4.9%) had prior AF and 254 (5.9%) had new-onset AF. Compared with no AF, new AF was associated with older age, male sex, first MI, worse baseline physical function, home atrioventricular nodal blocker use, and worse ventricular function (c-index 0.77). Rates of 1-year mortality were 6.2%, 14.5%, and 13.0%, and 1-year rehospitalization rates were 29.1%, 44.2%, and 36.8% for no, prior, and new AF, respectively. After multivariable adjustment, neither prior nor new AF was associated with increased 1-year mortality, and only prior AF was associated with increased risk of 1-year rehospitalization (Figure). After adjusting for baseline SF-12 physical function scores, patients with prior AF had lower 1-year scores than those with no AF (40.6 vs. 43.7, p <0.003), whereas patients with new AF had similar scores (42.9 vs. 43.7, p=0.36). Conclusion: New-onset AF during AMI is associated with a number of comorbidities but, unlike prior AF, is not associated with adverse outcomes. These results raise the question of whether AF is itself a cause of or simply a marker of comorbidities leading to downstream adverse outcomes after AMI.

scholarly journals Impact of cardiac- and noncardiac-related conditions on adverse outcomes in patients hospitalized with acute myocardial infarction

2019 ◽  
Vol 9 ◽  
pp. 2235042X1985249 ◽  
Author(s):  
Mayra Tisminetzky ◽  
Jerry H Gurwitz ◽  
Ruben Miozzo ◽  
Joel M Gore ◽  
Darleen Lessard ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Revascularization ◽  
Treatment Strategies ◽  
Adverse Outcomes ◽  
Post Discharge ◽  
Discharge Care ◽  
Significant Burden ◽  
Study Population ◽  
The Impact

Background: To examine the impact of cardiac- and noncardiac-related conditions on the risk of hospital complications and 7- and 30-day rehospitalizations in older adult patients with an acute myocardial infarction (AMI). Methods and Results: The study population consisted of 3863 adults aged 65 years and older hospitalized with AMI in Worcester, Massachusetts, during six annual periods between 2001 and 2011. Individuals were categorized into four groups based on the presence of 11 previously diagnosed cardiac and noncardiac conditions. The median age of the study population was 79 years and 49% were men. Twenty-eight percent of patients had two or less cardiac- and no noncardiac-related conditions, 21% had two or less cardiac and one or more noncardiac conditions, 20% had three or more cardiac and no noncardiac conditions, and 31% had three or more cardiac and one or more noncardiac conditions. Individuals who presented with one or more noncardiac-related conditions were less likely to have been prescribed evidence-based medications and/or to have undergone coronary revascularization procedures than patients without any noncardiac condition. After multivariable adjustment, individuals with three or more cardiac and one or more noncardiac conditions were at greatest risk for all adverse outcomes. Conclusions: Older patients hospitalized with AMI carry a significant burden of cardiac- and noncardiac-related conditions. Older adults who presented with multiple cardiac and noncardiac conditions experienced the worse short-term outcomes and treatment strategies should be developed to improve their in-hospital and post-discharge care and outcomes.

Abstract 107: Decade Long Trends (1999 - 2009) in Pre-hospital Delay and Short-term Mortality in Patients Hospitalized for Acute Myocardial Infarction - The Worcester Heart Attack Study

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Nathaniel Erskine ◽  
Jorge Yarzebski ◽  
Darleen M Lessard ◽  
Joel M Gore ◽  
Robert J Goldberg
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Medical Care ◽  
Case Fatality ◽  
Population Based ◽  
Short Term ◽  
Population Based Study ◽  
Medical Centers ◽  
Delay Times ◽  
Short Term Mortality

Objective: Patients experiencing signs and symptoms of an acute myocardial infarction (AMI) require prompt evaluation and treatment. There are little contemporary data, however, available on how the extent of delay between the onset of acute coronary symptoms and hospital presentation may impact short-term mortality. The purpose of this population-based study was to examine the relationship between extent of pre-hospital delay with hospital case-fatality rates (HCFRs) and 30-day post-admission mortality rates (PAMRs) among patients hospitalized with validated AMI in all central Massachusetts medical centers, and trends over time therein. Methods: We examined the medical records of residents of the Worcester, MA, metropolitan area hospitalized with a confirmed AMI at all 11 central MA medical centers on a biennial basis between 1999 and 2009 (n = 6,017). Information on patient’s demographic, medical history, clinical characteristics, and time of acute symptom onset and hospital arrival was abstracted. Results: Hospital medical record data on pre-hospital delay were available for 2,913 (48%) subjects of whom their mean age was 68 years, 38% were female, and 90% were Caucasian. The mean and median pre-hospital delay times were 4.0 hours and 2.0 hours, respectively, with little change noted in these times between 1999 and 2009. Patients who reported pre-hospital delay times greater than two hours were more likely to be older, female, and have a history of heart failure or diabetes mellitus as compared with patients who delayed seeking medical care by less than 2 hours. The overall HCFR was 6.6% and 30-day PAMR was 9.4%. The average HCFRs and 30-day PAMRs varied slightly between those with delay times of less than 2 hours (6.5%, 9.2%), 2 to 4 hours (6.3%, 8.6%), and greater than 4 hours (7.0%, 10.6%). No statistically significant changes in HCFRs and 30-day PAMRs were observed as pre-hospital delay times increased. Analyses of our principal study outcomes according to type of AMI (e.g., STEMI and NSTEMI) are ongoing and will be presented subsequently. Conclusions: This population-based study of residents of central MA hospitalized with AMI in all metropolitan Worcester medical centers showed little change in average and median pre-hospital delays between 1999 and 2009. Both the HCFRs and 30-day PAMRs were not significantly increased with greater durations of pre-hospital delay possibly due to potential confounders such as symptom severity. Our preliminary results suggest the need to further investigate trends in pre-hospital delay and short-term mortality, including patients who die in the community before receiving acute medical care.

Incidence and mortality of myocardial infarction among Catalonian older adults with and without underlying risk conditions: The CAPAMIS study

2018 ◽  
Vol 25 (17) ◽  
pp. 1822-1830 ◽  
Author(s):  
M José Forcadell ◽  
Angel Vila-Córcoles ◽  
Cinta de Diego ◽  
Olga Ochoa-Gondar ◽  
Eva Satué
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Population Based ◽  
Chronic Heart Disease ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
History Of ◽  
Artery Disease

Background Population-based data about the epidemiology of acute myocardial infarction is limited. This study investigated incidence and mortality of acute myocardial infarction in older adults with specific underlying chronic conditions and evaluated the influence of these conditions in developing acute myocardial infarction. Design and methods This was a population-based cohort study involving 27,204 individuals ≥ 60 years of age in Tarragona (Catalonia, Spain). Data on all cases of hospitalised acute myocardial infarction were collected from 1 December 2008–30 November 2011. Incidence rates and 30-day mortality were estimated according to age, sex, chronic illnesses and underlying conditions. Multivariable Cox regression analysis was used to calculate hazard ratios and to estimate the association between baseline conditions and risk of developing acute myocardial infarction. Results The incidence of acute myocardial infarction was 475 per 100,000 person-years. Maximum rates appeared among individuals with history of coronary artery disease (2839 per 100,000), chronic severe nephropathy (1407 per 100,000), atrial fibrillation (1226 per 100,000), chronic heart disease (1149 per 100,000), history of stroke (1147 per 100,000) and diabetes mellitus (914 per 100,000). Thirty-day mortality was 15.3% overall, reaching 31.6% among patients over 80 years. In the multivariable analysis, history of coronary artery disease, age > 70 years, sex male, chronic heart disease, history of stroke, atrial fibrillation, diabetes mellitus and hypertension emerged as significantly associated with an increased risk of acute myocardial infarction. Conclusions The incidence and mortality of acute myocardial infarction remain considerable in our setting. Considering classical major risk factors, diabetes mellitus and hypertension were the underlying conditions most strongly associated with an increased risk in our study population.

scholarly journals New-onset paroxysmal atrial fibrillation in acute myocardial infarction: increased risk of stroke

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039600
Author(s):  
Ji Hyun Lee ◽  
Sun-Hwa Kim ◽  
Wonjae Lee ◽  
Youngjin Cho ◽  
Si-Hyuck Kang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Multivariable Analysis ◽  
Hospital Death ◽  
Post Discharge ◽  
Increased Risk ◽  
All Cause Mortality ◽  
New Onset

ObjectiveTo investigate the long-term prognostic implications of transient new-onset atrial fibrillation (AF) in patients with acute myocardial infarction (AMI).DesignRetrospective observational study.SettingSingle tertiary centre.ParticipantsThis study included 2523 patients who presented with AMI from 3 June 2003 to 24 February 2015, after the exclusion of those with prior AF or in-hospital death.Outcome measuresPatients were divided into three groups according to the occurrence and type of new-onset AF: (1) sinus rhythm (SR) group; (2) paroxysmal AF (PaAF: AF converted to SR prior to discharge) group and (3) persistent AF (PeAF: AF persisted during the hospitalisation) group. Post-discharge all-cause mortality and stroke incidences were compared between the groups.ResultsNew-onset AF was observed in 271 patients (10.7%; PaAF: 230, PeAF: 41). The median follow-up period was 7.2 years (IQR: 5.2–9.4). The incidence of all-cause death and stroke was highest in the PeAF group, followed by the PaAF and SR groups (all-cause mortality: 48.8% vs 26.5% vs 14.7%, p<0.001; stroke 22.0% vs 8.3% vs 4.4%, p<0.001). In the multivariable analysis, PaAF and PeAF were associated with an increased risk of stroke (PaAF, HR: 1.972, 95% CI: 1.162–3.346; PeAF, HR: 5.160, CI: 2.242–11.873) compared with SR. The PaAF group showed a higher incidence of post-discharge AF than the SR group (29.1% vs 4.2%, p<0.001).ConclusionsNew-onset AF following AMI is associated with poor long-term outcomes. Even when AF episodes are brief and are converted to SR, new-onset AF remains associated with an increased risk of recurrent AF and stroke.

Influence of Sex on the Short-term Outcome of Elderly Patients With a First Acute Myocardial Infarction

Circulation ◽  
1995 ◽  
Vol 92 (5) ◽  
pp. 1133-1140 ◽  
Author(s):  
Héctor Bueno ◽  
M. Teresa Vidán ◽  
Aureliano Almazán ◽  
José L. López-Sendón ◽  
Juan L. Delcán
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Elderly Patients ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome

scholarly journals Association of Tooth Scaling with Acute Myocardial Infarction and Analysis of the Corresponding Medical Expenditure: A Nationwide Population-Based Study

2021 ◽  
Vol 18 (14) ◽  
pp. 7613
Author(s):  
Yi-Wei Kao ◽  
Ben-Chang Shia ◽  
Huei-Chen Chiang ◽  
Mingchih Chen ◽  
Szu-Yuan Wu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Periodontal Diseases ◽  
Population Based ◽  
Medical Expenditure ◽  
Control Group ◽  
Proportional Hazard ◽  
Population Based Study ◽  
Scaling Group

Accumulating evidence has shown a significant correlation between periodontal diseases and systemic diseases. In this study, we investigated the association between the frequency of tooth scaling and acute myocardial infarction (AMI). Here, a group of 7164 participants who underwent tooth scaling was compared with another group of 7164 participants without tooth scaling through propensity score matching to assess AMI risk by Cox’s proportional hazard regression. The results show that the hazard ratio of AMI from the tooth scaling group was 0.543 (0.441, 0.670) and the average expenses of AMI in the follow up period was USD 265.76, while the average expenses of AMI in follow up period for control group was USD 292.47. The tooth scaling group was further divided into two subgroups, namely A and B, to check the influence of tooth scaling frequency on AMI risk. We observed that (1) the incidence rate of AMI in the group without any tooth scaling was 3.5%, which is significantly higher than the incidence of 1.9% in the group with tooth scaling; (2) the tooth scaling group had lower total medical expenditures than those of the other group because of the high medical expenditure associated with AMI; and (3) participants who underwent tooth scaling had a lower AMI risk than those who never underwent tooth scaling had. Therefore, the results of this study demonstrate the importance of preventive medicine.

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