(Circulation. 2000;101:969.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Acute Myocardial Infarction Complicated by Atrial Fibrillation in the Elderly
Prevalence and Outcomes
From the Clinical Economics Research Unit (S.S.R., K.P.W., K.A.S.) and Division of Cardiology (A.K.B., B.J.G., A.J.S.), Georgetown University Medical Center, Washington, DC, and Maryland HealthCare Associates, LLC, Clinton, Md, and Delmarva Foundation for Medical Care, Incorporated, Easton, Md (W.J.O.).
Correspondence to Allen J. Solomon, MD, Division of Cardiology, Room M4222, Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007. E-mail solomona{at}gunet.georgetown.edu
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionReferences |
|---|
Background—Although atrial fibrillation (AF) is a common complication of acute myocardial infarction (MI), patient characteristics and association with outcomes remain poorly defined in the elderly.
Methods and Results—We evaluated 106 780 Medicare beneficiaries
65 years of age from the Cooperative Cardiovascular
Project treated for acute MI between January 1994 and February 1996
to determine the prevalence and prognostic significance of AF
complicating acute MI in elderly patients. Patients were categorized on
the basis of the presence of AF, and those with AF were further
subdivided by time of AF (present on arrival versus developing
during hospitalization). AF and non-AF patients were compared by
univariate analysis, and logistic regression
modeling was used to identify clinical predictors of AF. The influence
of AF on outcomes was evaluated by unadjusted Kaplan-Meier survival
curves and logistic regression models. AF was documented in 23 565
patients (22.1%): 11 510 presented with AF and 12 055
developed AF during hospitalization. AF patients were older, had more
advanced heart failure, and were more likely to have had a prior MI and
undergone coronary revascularization. AF
patients had poorer outcomes, including higher in-hospital (25.3%
versus 16.0%), 30-day (29.3% versus 19.1%), and 1-year (48.3%
versus 32.7%) mortality. AF remained an independent predictor of
in-hospital (odds ratio [OR], 1.21), 30-day (OR, 1.20), and 1-year
(OR, 1.34) mortality after multivariate adjustment.
Patients developing AF during hospitalization had a worse prognosis
than patients who presented with AF.
Conclusions—AF is a common complication of acute MI in elderly patients and independently influences mortality, particularly when it develops during hospitalization.
Key Words: infarction • fibrillation • mortality
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Atrial fibrillation is a common complication of acute myocardial infarction (MI), with a reported incidence as high as 20%.1 Despite its frequent occurrence, the prognostic significance of atrial fibrillation complicating acute MI remains controversial. Although some studies have identified increased in-hospital and long-term mortality associated with atrial fibrillation,2 3 4 5 others have found no independent effect.1 6 7 8 9 Further complicating the issue are comorbid conditions that may be associated with survival after acute MI. It remains unclear whether atrial fibrillation is a marker for overall poorer clinical status or independently influences patient outcomes.
Previous studies of atrial fibrillation have been limited by small sample sizes,6 8 9 enrollment at a few study centers,1 5 6 9 short follow-up periods,6 8 and evaluation of patients from clinical trial populations.2 3 4 7 Although the prevalence of atrial fibrillation is known to increase with age,1 few studies have investigated the incidence or prognostic significance of atrial fibrillation in elderly patients with acute MI. The Cooperative Cardiovascular Project (CCP), a data set of 234 769 Medicare patients hospitalized for acute MI, permits such an evaluation. Using detailed clinical data from the CCP, we sought to determine the incidence of atrial fibrillation in elderly patients with acute MI, clinical factors associated with its presentation, and its association with patient outcomes.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
The CCP
Initiated by the Health Care Financing Administration in 1992 in collaboration with peer review organizations, the CCP is an ongoing national program developed to improve the quality of care for Medicare beneficiaries with acute MI.10 The CCP cohort includes all Medicare beneficiaries discharged from a nonfederal short-term care hospital in the United States with a primary discharge diagnosis of acute MI (International Classification of Disease, ninth revision [ICD-9], code 410) between January 1994 and February 1996, except for acute MI readmissions (ICD-9 code 410.x2).11 Patients were identified on the basis of hospital bills (UB-92 claims) in the Medicare National Claims History File associated with hospitalizations during a random 8-month period, which varied for each state.12
Medical records for each sampled hospitalization were forwarded to clinical data abstraction centers. CCP data abstraction and management have been reported elsewhere13 and include 140 predefined clinical variables associated with each hospitalization. Data were collected within the following categories: demographics; medications; patient medical histories; symptoms on arrival; diagnostic tests, including ECG examination, laboratory test results, and in-hospital treatment and events; and discharge treatment and disposition. Data quality was ensured through the use of trained technicians and software abstraction modules and was monitored by random record reabstraction. Data reliability averaged 94%.14
Study Sample
We limited our analysis to patients 65 years of age
presenting with confirmed acute MI. Confirmed acute MI was defined
as an elevation of creatine kinase-MB level >5%, an elevation of
lactate dehydrogenase enzyme (LDH) levels with isoenzyme reversal (LDH
1>LDH 2), or 2 of the following 3 criteria: chest pain during the
prior 48 hours, a 2-fold elevation in creatine kinase, or
diagnostic ECG changes (ST-segment elevation or new Q
waves). Patients with multiple admissions during the sample period were
identified, and readmissions for acute MI were excluded. Patients
transferred between hospitals were excluded because we could not
evaluate their full hospitalization. We excluded patients for whom ECG
data were not available. Finally, we excluded 3 patients for whom we
could not evaluate mortality status. All remaining patients
(n=106 780) constituted the study cohort (Table 1
).
|
Study Outcomes
Our principal outcome of interest was the development of atrial
fibrillation at any point during the MI hospitalization. Atrial
fibrillation was defined as a diagnosis of atrial fibrillation or
flutter reported on a patient’s ECG if accompanied by an ECG report or
physician’s interpretation. Because the timing of atrial fibrillation
may influence its prognostic significance, we further classified
patients on the basis of when atrial fibrillation was first recognized.
Patients with atrial fibrillation documented on their admission ECG
(performed within 6 hours of arrival) were classified as having atrial
fibrillation on arrival. This group included patients with chronic
atrial fibrillation and those who developed atrial fibrillation early
in their infarction. Patients who did not have atrial fibrillation on
arrival but subsequently developed this arrhythmia during their
hospitalization were classified as developing atrial fibrillation
during hospitalization.
Our second outcome of interest was mortality during hospitalization, at 30 days, and at 1 year. We examined the influence of atrial fibrillation on mortality using data obtained from the Medicare Enrollment Database.15 We also examined the association of atrial fibrillation and in-hospital outcomes, including reinfarction, cerebrovascular accident, intensive care unit (ICU) admission, congestive heart failure, and length of hospitalization.
Statistical Analyses
We first sought to determine the prevalence and time of onset of
atrial fibrillation during the acute MI hospitalization. Development of
atrial fibrillation and time of atrial fibrillation recognition were
evaluated for bivariate associations with patients’ demographic and
clinical characteristics with 
2 and
t test analyses. Variables incorporated into our
analysis included demographic characteristics—race and
sex—and characteristics previously identified as predictors of acute
MI mortality in the Global Utilization of Streptokinase and Tissue
Plasminogen Activator for Occluded
Coronary Arteries (GUSTO) trial.16 These
variables included age, systolic blood pressure on arrival,
pulse rate, MI location, Killip class, height, weight, prior history of
infarction, history of CABG, smoking status, current diabetes mellitus,
hypertension, and cerebrovascular disease. Significant patient
demographic and clinical characteristics from the bivariate
analyses (P<0.05) were incorporated into a
multivariable logistic regression model, with development of atrial
fibrillation as the dependent variable. Variables were removed
from the model by backward stepwise selection with a significance level
of P<0.05.
In the second portion of our study, we evaluated the association of
atrial fibrillation with patient outcomes, including in-hospital events
and in-hospital mortality, at 30 days and 1 year by
2 and t test analysis.
Kaplan-Meier plots were used to illustrate unadjusted mortality at 1
year for patients without atrial fibrillation, those presenting
with atrial fibrillation, and those developing atrial fibrillation
during hospitalization. Logistic regression modeling was used to
identify the unadjusted risk of in-hospital mortality attributable to
any atrial fibrillation, atrial fibrillation on arrival, and atrial
fibrillation during hospitalization. The independent risk of
in-hospital mortality attributable to atrial fibrillation, atrial
fibrillation on arrival, and atrial fibrillation developing during
hospitalization was then determined by addition of patient demographic
and clinical characteristics to the model. Because antiarrhythmic
agents may induce ventricular proarrhythmia and
increase a patient’s mortality risk, antiarrhythmic agents used on
admission and during hospitalization were identified and incorporated
into the mortality model. Logistic regression modeling was repeated to
evaluate the association of atrial fibrillation and mortality at 30
days and 1 year. The 1-year mortality model was augmented to include
antiarrhythmic agents prescribed on discharge, in addition to agents
used on admission and during hospitalization.
To maximize regression modeling, age, systolic blood pressure, and pulse rate were evaluated for their relationship with 30-day mortality to determine appropriate model fitting transformations with fractional polynomial modeling.17 Logistic model fit was evaluated by inspection of predicted and expected frequencies, and model discrimination was assessed by the c statistic. Because of significant missing data rates for height (16.1%) and weight (8.6%), analyses were performed on the smaller cohort with full data (including height and weight) and the larger study cohort, with height and weight omitted. Findings were unchanged; thus, height and weight were subsequently excluded from final analytical models. All models demonstrated appropriate calibration and discrimination (c=360.75).
Logistic regression models were also applied to 3 modified cohorts to determine whether any mortality risk attributable to atrial fibrillation was limited to particular subsets of arrhythmia patients. In the first cohort, we excluded all patients who underwent CABG because they may have developed atrial fibrillation as a complication of surgery. To account for the possibility that atrial fibrillation may be a marker for terminal illness, we excluded all patients with a life expectancy of <6 months from our second cohort. In our third cohort, we excluded patients who died during hospitalization to account for the possibility that atrial fibrillation may be a marker for more severe illness or represent a patient subset at greater risk for mortality.
All calculations were performed by use of the SAS 6.12 (SAS Institute) and STATA 6.0 (STATA Corp) software packages.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Of the 106 780 patients in the study cohort, 23 565 (21%) had atrial fibrillation during the course of their acute MI: 11 510 patients (10.8%) had atrial fibrillation on arrival, and 12 055 (11.3%) developed atrial fibrillation during hospitalization. Atrial fibrillation patients were older and more likely to be white; had higher Killip classes, higher admission heart rates, lower systolic blood pressures, more anterior MIs, and higher rates of prior cerebrovascular disease; and were less likely to smoke than patients without this arrhythmia (Table 2
). Sex was not associated with the
occurrence of atrial fibrillation.
|
Clinical characteristics of patients with atrial fibrillation differed,
depending on the time of atrial fibrillation recognition. Patients with
atrial fibrillation documented on arrival were older, had a higher
heart rate, had more advanced heart failure, and were more likely to
have a history of CABG, prior MI, and cerebrovascular disease compared
with patients developing atrial fibrillation in hospital (Table 2
). Finally, sex was associated with time of atrial fibrillation
onset because women were more likely to present with atrial
fibrillation. Time of atrial fibrillation onset was comparable among
racial groups.
Multivariate modeling indicated that advanced heart
failure (Killip class IV) was the most significant predictor of the
development of atrial fibrillation (odds ratio [OR], 1.58; 95% CI,
1.45 to 1.73). Other significant predictors included heart rate, age,
systolic blood pressure, anterior MI location, race, prior MI,
prior cerebrovascular disease, hypertension, time to
presentation, and current smoking status (Table 3). Prior CABG was not significantly
associated with the development of atrial fibrillation.
|
Patients with atrial fibrillation had significantly worse outcomes,
including higher in-hospital, 30-day, and 1-year mortality (Table 4). When stratified by time of onset,
patients developing atrial fibrillation during hospitalization had
higher in-hospital and 30-day mortality rates compared with those
presenting with atrial fibrillation and patients without atrial
fibrillation. The difference in mortality rates between patients
presenting with and developing atrial fibrillation decreased over
time and was not significant at 1 year (the Figure).
|
|
Patients with atrial fibrillation had more frequent in-hospital events,
including reinfarction, cerebrovascular accident, congestive heart
failure, and ICU admission (Table 4). In addition, patients with
atrial fibrillation remained in the hospital 2 days longer on average
(9.6 versus 7.6 days, P<0.0001) than patients without this
arrhythmia. In-hospital events were more frequent and length of
stay was longer for patients developing atrial fibrillation during
hospitalization compared with patients presenting with atrial
fibrillation.
Patients with atrial fibrillation remained at significantly greater
risk for mortality in hospital (OR, 1.21; 95% CI, 1.17 to 1.26), at 30
days (OR, 1.20; 95% CI, 1.16 to 1.24), and at 1 year (OR, 1.34; 95%
CI, 1.30 to 1.39) after adjustment for demographic characteristics,
clinical factors and the use of antiarrhythmic agents (Table 5). The prognostic significance of atrial
fibrillation varied by time of onset. Patients presenting with
atrial fibrillation were statistically comparable to patients without
atrial fibrillation for in-hospital mortality (OR, 1.05; 95% CI, 0.99
to 1.10) and had a small risk for 30-day (OR, 1.06; 95% CI, 1.01 to
1.11) and 1-year (OR, 1.16; 95% CI, 1.11 to 1.21) mortality. In
contrast, patients developing atrial fibrillation during
hospitalization had the highest risk of in-hospital (OR, 1.35; 95% CI,
1.28 to 1.42), 30-day (OR, 1.31; 95% CI, 1.25 to 1.37), and 1-year
(OR, 1.51; 95% CI, 1.44 to 1.58) mortality. Findings were unchanged
when evaluated in the 3 restricted cohorts excluding coronary
artery bypass, terminally ill, and in-hospital mortality patients
(results not shown).
|
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Use of the CCP cohort provides a unique opportunity to study the role of atrial fibrillation in elderly acute MI patients. First, this is the first study to evaluate the role of atrial fibrillation in an exclusively elderly population. The advanced age of our study cohort allowed evaluation of a population traditionally excluded from clinical trials and rarely seen in large numbers in most centers. Second, the study provides a national perspective on the role of atrial fibrillation and is not restricted to a few centers or geographical areas. Third, the CCP contains data on Medicare beneficiaries treated for acute MI, thereby including more critically ill patients and those with comorbidities who are often excluded from clinical trial populations. Finally, the size of the CCP database provides the largest evaluation of atrial fibrillation complicating acute MI to date. With this size, we gain statistical power to detect trends in atrial fibrillation and outcomes that other studies have generally been underpowered to evaluate.
Atrial fibrillation was a common complication of acute MI in this elderly cohort, with a prevalence of 22.1%. Patients developing atrial fibrillation were older and represented a sicker population with poorer outcomes compared with other elderly acute MI patients. Our findings build on previous research documenting the common occurrence of atrial fibrillation during acute MI and its association with adverse outcomes during hospitalization and after discharge.1 2 3 4 5 6 7 8 9 18 Patients developing atrial fibrillation during hospitalization had worse in-hospital outcomes, suggesting that different times of atrial fibrillation onset may represent different pathophysiologies and thus influence prognosis differently.
Atrial fibrillation was associated with higher mortality during hospitalization, at 30 days, and at 1 year. Mortality rates were significantly higher than those reported for patients in the GUSTO trial during hospitalization (25.3% versus 13.8%), at 30 days (29.3% versus 14.3%), and at 1 year (48.3% versus 21.5%).4 However, GUSTO enrolled thrombolytic-eligible patients19 who, in general, were healthier and younger than the cohort of elderly acute MI patients in the CCP. Our mortality rates were similar to the 30-day mortality of 25.1% and 1-year mortality of 38.4% in the expanded Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT) registry3 Although SPRINT used a more inclusive enrollment,20 its population also included a significantly younger cohort than our study population.2 3 This difference is particularly striking because the mean age for atrial fibrillation patients in the CCP (79.2 years) is more than a full decade older than arrhythmia patients enrolled in SPRINT and GUSTO.
Whereas previous studies have provided conflicting findings concerning the association of atrial fibrillation and mortality,1 2 3 4 5 6 7 8 9 we found atrial fibrillation to be an independent risk factor for short- and long-term mortality. The prognostic significance of atrial fibrillation, however, varied, depending on time of atrial fibrillation onset. Patients with atrial fibrillation on arrival had a small risk of mortality, while those developing atrial fibrillation during hospitalization had a markedly increased risk of mortality. A similar finding was reported in the GUSTO trial, in which only atrial fibrillation developed during hospitalization was independently associated with mortality.4 This difference may be explained by the fact that patients with atrial fibrillation on arrival likely included a cohort of patients with chronic atrial fibrillation,4 whereas patients who developed atrial fibrillation during hospitalization likely exhibited this arrhythmia as a consequence of their infarct. Sakata et al5 observed an increased mortality risk for patients developing atrial fibrillation during hospitalization after excluding patients presenting with chronic atrial fibrillation. Although the time of atrial fibrillation onset may represent different processes, the presence of atrial fibrillation remains a marker of prognostic significance in the elderly.
Atrial fibrillation has consistently been identified as an independent mortality risk at long-term follow-up. However, findings have been inconclusive for short-term mortality; GUSTO noted an independent effect of atrial fibrillation–related mortality 30 days after infarction,4 whereas SPRINT found no effect.3 Furthermore, no study has found atrial fibrillation to be an independent predictor of mortality during hospitalization.1 2 3 4 5 6 7 8 9 This pattern had suggested that atrial fibrillation took on prognostic significance only if patients survived the peri-infarction period. However, our findings differ from those of previous analyses. We observed an independent, increased risk of mortality in hospital, at 30 days, and at 1 year among patients with atrial fibrillation. Thus, our data suggest that atrial fibrillation influences mortality during the infarction and recovery period in elderly patients and is not limited to long-term follow-up.
The cause of atrial fibrillation during acute MI remains unclear. Possible mechanisms include pericarditis, atrial ischemia or infarction, increased catecholamines, metabolic abnormalities, and increased atrial pressures. As in prior studies,1 2 3 5 6 7 we noted poorer clinical status and significant comorbidity among patients with atrial fibrillation, including advanced Killip class, increased heart rate, and lower systolic blood pressure. These findings suggest that hemodynamic factors may influence the development of atrial fibrillation and parallel reports of poorer hemodynamic status documented in other studies.4 5 6 8 21 Although previous studies identified age, hemodynamic, and ECG factors4 6 22 as the primary predictors of atrial fibrillation, we found advanced Killip class to be the greatest predictor of atrial fibrillation. The diminished importance of age in our analysis may reflect the advanced age (mean age, 77.4 years) of our cohort compared with most previous analyses.
Our study has several limitations. We relied on data from a retrospective chart analysis. As a result, we were unable to determine the precise onset or duration of atrial fibrillation, and thus we could not distinguish effects attributable to paroxysmal versus chronic atrial fibrillation. Patients with atrial fibrillation on arrival may include those with chronic arrhythmias and those with new-onset arrhythmias. Similarly, we were unable to evaluate the permanence of atrial fibrillation after hospitalization. In addition, we were unable to evaluate patients’ specific clinical sequence of in-hospital events. Given that in-hospital events likely influence mortality and that we adjusted only for patient history and arrival findings, the risk of mortality attributable to atrial fibrillation developing during hospitalization may be overestimated.
Conclusions
Atrial fibrillation is a common complication of acute MI in the
elderly, occurring in >22% of patients in our study cohort. Patients
with atrial fibrillation were older, were in worse health, and had
significantly worse outcomes during hospitalization and after
discharge. Although baseline clinical status may have predisposed
patients to poorer outcomes, atrial fibrillation was independently
associated with increased mortality. The influence of atrial
fibrillation was greatest for patients developing atrial fibrillation
during hospitalization. Greater attention to the management of atrial
fibrillation complicating acute MI in the elderly, particularly among
high-risk patients, may be warranted.
|
Acknowledgments |
|---|
This research was supported by contracts 500-96-P623 and 500-96-P624 sponsored by the Delmarva Foundation for Medical Care, Inc, and the US Health Care Financing Administration. The contents of this publication do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care.
|
Footnotes |
|---|
Dr Berger is currently with the Division of Cardiology, Yale-New Haven Medical Center, New Haven, Conn, and Dr Gersh is now with the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn.
Received July 30, 1999; revision received September 9, 1999; accepted September 23, 1999.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
1. Goldberg RJ, Seeley D, Becker RC. Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community wide perspective. Am Heart J. 1990;119:996–1001.[Medline] [Order article via Infotrieve]
2.
Behar S, Zahavi Z, Goldbourt U, Reicher-Reiss H, for
the SPRINT Study Group. Long-term prognosis of patients with paroxysmal
atrial fibrillation complicating acute myocardial infarction. Eur
Heart J. 1992;13:45–50.
3.
Eldar M, Canetti M, Rotstein Z, Boyko V, Gottlieb S,
Kaplinsky E, Behar S, for the SPRINT and Thrombolytic
Survey groups. Significance of paroxysmal atrial fibrillation
complicating acute myocardial infarction in the
thrombolytic era. Circulation. 1998;97:965–970.
4. Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM, for the GUSTO-I Trial Investigators. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. J Am Coll Cardiol. 1997;30:406–413.[Abstract]
5. Sakata K, Kurihara H, Iwamori K, Maki A, Yoshino H, Yanagisawa A, Ishikawa K. Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction. Am J Cardiol. 1997;80:1522–1527.[Medline] [Order article via Infotrieve]
6. Madias JE, Patel DC, Singh D. Atrial fibrillation in acute myocardial infarction: a prospective study based on data from a consecutive series of patients admitted to the coronary care unit. Clin Cardiol. 1996;19:180–186.[Medline] [Order article via Infotrieve]
7. Vaage-Nilsen M, Hansen JF, Mellemgaard K, Hagerup L, Sigurd B, Steinmetz E, for the DAVIT II Study Group. Short- and long-term prognostic implications of in-hospital postinfarction arrhythmias. Cardiology. 1995;86:49–55.[Medline] [Order article via Infotrieve]
8. Sugiura T, Iwasaka T, Ogawa A, Shiroyama Y, Tsuji H, Onoyama H, Inada M. Atrial fibrillation in acute myocardial infarction. Am J Cardiol. 1985;56:27–29.[Medline] [Order article via Infotrieve]
9. Serrano CV, Ramiers JAF, Mansur AP, Pileggi F. Importance of the time of onset of supraventricular tachyarrhythmias on prognosis of patients with acute myocardial infarction. Clin Cardiol. 1995;18:84–90.[Medline] [Order article via Infotrieve]
10.
Jencks SF, Wilensky GR. The Health Care Quality
Improvement Initiative: a new approach to quality insurance in
Medicare. JAMA. 1992;268:900–909.
11. International Classification of Diseases, 9th Revision: Clinical Modification. Ann Arbor, Mich: Commission on Professional and Hospital Activities; 1991.
12.
O’Connor GT, Quinton HB, Traven ND, Ramunno LD, Dodds
TA, Marciniak TA, Wennberg JE. Geographic variation in the treatment of
acute myocardial infarction: the Cooperative
Cardiovascular Project. JAMA. 1999;281:627–633.
13. Vogel RA. HCFA’s Cooperative Cardiovascular Project: a nationwide quality assessment of acute myocardial infarction. Clin Cardiol. 1994;17:354–356.[Medline] [Order article via Infotrieve]
14.
Marciniak TA, Ellerbeck EF, Radford MJ, Kresowik TF,
Gold JA, Krumholz HM, Kiefe CI, Allman RM, Vogel RA, Jencks SF.
Improving the quality of care for Medicare patients with acute
myocardial infarction. JAMA. 1998;279:1351–1357.
15. Fleming C, Fisher ES, Chang C-H, Bubolz TA, Melenka DJ. Studying outcomes and hospital utilization in the elderly. Med Care. 1992;30:377–391.[Medline] [Order article via Infotrieve]
16.
Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col
J, Simoons M, Aylward P, Van de Werf F, Califf RM, for the GUSTO-I
Investigators. Predictors of 30-day mortality in the era of reperfusion
for acute myocardial infarction: results from an international trial of
41 021 patients. Circulation. 1995;92:2811–2818.
17. Royston P, Altman DG. Regression using fractional polynomials of continuous variables: parsimonious parametric modeling. Appl Stat. 1994;43:429–467.
18. Laupacis A, Cuddy E. Canadian Cardiovascular Society Consensus Conference on Atrial Fibrillation: prognosis of individuals with atrial fibrillation. Can J Cardiol. 1996;12:14A–16A.
19.
GUSTO-I Investigators. An international randomized
trial comparing four thrombolytic strategies for acute
myocardial infarction. N Engl J Med. 1993;329:673–682.
20.
Israeli SPRINT Study Group. Secondary Prevention
Reinfarction Israeli Nifedipine Trial (SPRINT): a
randomized intervention trial of nifedipine in patients
with myocardial infarction. Eur Heart J. 1988;9:354–364.
21. Sugiura T, Iwasaka T, Takahashi N, Nakamura S, Taniguchi H, Nagahama Y, Matsutani M, Inada M. Atrial fibrillation in inferior wall Q-wave acute myocardial infarction. Am J Cardiol. 1991;67:1135–1136.[Medline] [Order article via Infotrieve]
22. Flugelman MY, Hasin Y, Shefer A, Sebbag D, Freiman I, Gotsman MS. Atrial fibrillation in acute myocardial infarction. Isr J Med Sci. 1986;22:355–359.[Medline] [Order article via Infotrieve]
This article has been cited by other articles:
 |
|
 |
|
  R. D. Lopes, L. E. Elliott, H. D. White, J. S. Hochman, F. Van de Werf, D. Ardissino, T. T. Nielsen, W. D. Weaver, P. Widimsky, P. W. Armstrong, et al. Antithrombotic therapy and outcomes of patients with atrial fibrillation following primary percutaneous coronary intervention: results from the APEX-AMI trial Eur. Heart J., August 2, 2009; 30(16): 2019 - 2028. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Schmitt, G. Duray, B. J. Gersh, and S. H. Hohnloser Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications Eur. Heart J., May 1, 2009; 30(9): 1038 - 1045. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, F. Van de Werf, J. Bax, A. Betriu, C. Blomstrom-Lundqvist, F. Crea, V. Falk, G. Filippatos, K. Fox, K. Huber, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology: Eur. Heart J., December 1, 2008; 29(23): 2909 - 2945. [Full Text] [PDF]
|
|
|
|
 |
|
 R D Lopes, K S Pieper, J R Horton, S M Al-Khatib, L K Newby, R H Mehta, F Van de Werf, P W Armstrong, K W Mahaffey, R A Harrington, et al. Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation Heart, July 1, 2008; 94(7): 867 - 873. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Sakabe, A. Shiroshita-Takeshita, A. Maguy, B. J.J.M. Brundel, A. Fujiki, H. Inoue, and S. Nattel Effects of a heat shock protein inducer on the atrial fibrillation substrate caused by acute atrial ischaemia Cardiovasc Res, April 1, 2008; 78(1): 63 - 70. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Ehrlich, P. Biliczki, S. H. Hohnloser, and S. Nattel Atrial-Selective Approaches for the Treatment of Atrial Fibrillation J. Am. Coll. Cardiol., February 26, 2008; 51(8): 787 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): 854 - 906. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): e257 - e354. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): 700 - 752. [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Eur. Heart J., August 2, 2006; 27(16): 1979 - 2030. [Full Text] [PDF]
|
|
|
|
|
|
O. D. Pedersen, S. Z. Abildstrom, M. M. Ottesen, C. Rask-Madsen, H. Bagger, L. Kober, C. Torp-Pedersen, and on behalf of the TRACE study investigators Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction Eur. Heart J., February 1, 2006; 27(3): 290 - 295. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. G. Kushner and E. M. Antman Oral Anticoagulation for Atrial Fibrillation After ST-Elevation Myocardial Infarction: New Evidence to Guide Clinical Practice Circulation, November 22, 2005; 112(21): 3212 - 3214. [Full Text] [PDF]
|
|
|
|
|
|
U. Stenestrand, J. Lindback, L. Wallentin, and for the RIKS-HIA Registry Anticoagulation Therapy in Atrial Fibrillation in Combination With Acute Myocardial Infarction Influences Long-Term Outcome: A Prospective Cohort Study From the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA) Circulation, November 22, 2005; 112(21): 3225 - 3231. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. S. Yancy Jr, M. K. Olsen, L. H. Curtis, K. A. Schulman, M. S. Cuffe, and E. Z. Oddone Variations in Coronary Procedure Utilization Depending on Body Mass Index Arch Intern Med, June 27, 2005; 165(12): 1381 - 1387. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Asanin, J. Perunicic, I. Mrdovic, M. Matic, B. Vujisic-Tesic, A. Arandjelovic, Z. Vasiljevic, and M. Ostojic Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction Eur J Heart Fail, June 1, 2005; 7(4): 671 - 676. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. McMurray, L. Kober, M. Robertson, H. Dargie, W. Colucci, J. Lopez-Sendon, W. Remme, D. N. Sharpe, and I. Ford Antiarrhythmic effect of carvedilol after acute myocardial infarction: Results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial J. Am. Coll. Cardiol., February 15, 2005; 45(4): 525 - 530. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lehto, S. Snapinn, K. Dickstein, K. Swedberg, M. S. Nieminen, and on behalf of the OPTIMAAL investigators Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: the OPTIMAAL experience Eur. Heart J., February 2, 2005; 26(4): 350 - 356. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Athanasiou, O. Aziz, O. Mangoush, A. Weerasinghe, S. Al-Ruzzeh, S. Purkayastha, J. Pepper, M. Amrani, B. Glenville, and R. Casula Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting? Ann. Thorac. Surg., May 1, 2004; 77(5): 1567 - 1574. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. S. Aronow Management of the Older Person With Atrial Fibrillation J. Gerontol. A Biol. Sci. Med. Sci., June 1, 2002; 57(6): M352 - 363. [Abstract] [Full Text]
|
|
|
|
|
|
Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1266 - 1266. [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||