(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
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
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