title: Relation of Atrial Fibrillation in Acute Myocardial Infarction to In-Hospital Complications and Early Hospital Readmission.
abstract: Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) and contributes to high rates of in-hospital adverse events. However, there are few contemporary studies examining rates of AF in the contemporary era of AMI or the impact of new-onset AF on key in-hospital and postdischarge outcomes. We examined trends in AF in 6,384 residents of Worcester, Massachusetts, who were hospitalized with confirmed AMI during 7 biennial periods between 1999 and 2011. Multivariate logistic regression analysis was used to examine associations between occurrence of AF and various in-hospital and postdischarge complications. The overall incidence of AF complicating AMI was 10.8%. Rates of new-onset AF increased from 1999 to 2003 (9.8% to 13.2%), and decreased thereafter. In multivariable adjusted models, patients developing new-onset AF after AMI were at a higher risk for in-hospital stroke (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.6 to 4.1), heart failure (OR 2.0, 95% CI 1.7 to 2.4), cardiogenic shock (OR 3.7, 95% CI 2.8 to 4.9), and death (OR 2.3, 95% CI 1.9 to 3.0) than patients without AF. Development of AF during hospitalization for AMI was associated with higher rates of readmission within 30 days after discharge (21.7% vs 16.0%), but no significant difference was noted in early postdischarge 30-day all-cause mortality rates (8.3% vs 5.1%). In conclusion, new-onset AF after AMI is strongly related to in-hospital complications of AMI and higher short-term readmission rates.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Amartya
authors.initials: A
authors.lastname: Kundu
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Day
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Amir Y
authors.initials: AY
authors.lastname: Shaikh
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Darleen M
authors.initials: DM
authors.lastname: Lessard
authors.affiliation: Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Chad E
authors.initials: CE
authors.lastname: Darling
authors.affiliation: Department of Medicine, St. Vincent Hospital, Worcester, Massachusetts.
authors.forename: Ramses
authors.initials: R
authors.lastname: Thabet
authors.affiliation: Department of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Mohammed W
authors.initials: MW
authors.lastname: Akhter
authors.affiliation: Department of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Floyd
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: Department of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: mcmanusd@ummhc.org.
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D016017:Odds Ratio; D010359:Patient Readmission / Q000639:trends*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors