Atrial fibrillation (AF) often complicates myocardial infarction (MI). While AF adversely impacts survival in MI patients, the impact of AF on healthcare utilization has not been studied.
The risk of hospitalizations, emergency department (ED) visits, and outpatient visits associated with prior, early-onset (<30 days post-MI) and late-onset (≥30 days post-MI) AF was assessed among incident MI patients from the Olmsted County, MN community.
Of 1502 MI patients, 237 had prior AF, 163 developed new-onset AF, 113 developed late-onset AF, and 989 had no AF. Over a mean follow-up of 3.9 years, 3661 hospitalizations, 5559 ED visits, and 80,240 outpatient visits occurred. After adjustment, compared to patients without AF, those with prior and early-onset AF exhibited a 1.6-fold and 1.4-fold increased risk of hospitalization, respectively. In contrast, late-onset AF carried a 2.2-fold increased risk of hospitalization. The hazard ratios were 1.4, 1.2, and 1.8 for ED visits and 1.5, 1.2, and 1.7 for outpatient visits for prior, early-onset, and late-onset AF. Additional adjustment for time-dependent recurrent MI and heart failure attenuated the results slightly for hospitalizations and ED visits; however, patients with late-onset AF still exhibited more than a 50% increased risk for both utilization measures.
In MI patients, the risk of hospitalizations, ED visits, and outpatient visits differed by the timing of AF onset, with the greatest risk conferred by late-onset AF. AF imparts an adverse prognosis after MI underscoring the importance of its management in MI patients.