By Will Boggs, MD
NEW YORK, Mar 06 (Reuters Health) -- Atrial fibrillation, an erratic heart
rhythm, commonly accompanies heart attacks among people aged 65 years and older
and is associated with more complications and a higher death rate, report US
researchers.
The finding comes from a large study of elderly heart attack patients.
"We didn't think atrial fibrillation would be as common as we found it to
be," said Dr. Allen J. Solomon from Georgetown University Medical Center in
Washington, DC, in a statement. "(The elderly) have their own set of
complications, many of which are different than those seen in younger
populations."
Among nearly 107,000 elderly patients admitted to the hospital for a heart
attack, 21% had atrial fibrillation -- about half of these on arrival and about
half later during their hospitalization, according to Solomon and his
colleagues. Their report is published in the March 7th issue of Circulation:
Journal of the American Heart Association.
Elderly heart attack patients with atrial fibrillation were older and sicker
than those without atrial fibrillation, the researchers report.
Even taking other risk factors into account, patients with atrial
fibrillation were about 20% more likely than other elderly heart attack patients
to die in the hospital within 30 days of their heart attack, or during the first
year after their heart attack, the results indicate.
Atrial fibrillation was also linked to a higher rate of developing heart
failure, strokes, or repeat heart attacks, the investigators note, and hospital
stays were an average 2 days longer for patients with atrial fibrillation.
Complications were especially common among those patients who developed
atrial fibrillation during their hospital stays, and their death rates in the
hospital and 30 days after their heart attacks were slightly higher than those
among patients who already had atrial fibrillation, the report indicates.
"This is the first study to evaluate the role of atrial fibrillation in an
exclusively elderly population," the investigators write. "Greater attention to
the management of atrial fibrillation complicating (heart attack) in the
elderly, particularly among high-risk patients, may be warranted."
"We'd like to be able to find out how to prevent (atrial fibrillation) in
these patients," Solomon told Reuters Health in an interview. "Other evidence
from the Medicare database demonstrates that elderly patients are much less
likely to receive accepted therapies for acute (heart attack) -- things like
aspirin, revascularization (bypass operations or angioplasty), and
beta-blockers. Maybe those treatments could reduce (atrial fibrillation) and
improve outcomes."
Solomon added that his team is now focusing on how to prevent and how to
treat atrial fibrillation in elderly patients who have had a heart attack. "They
should probably receive anticoagulation (blood thinners)" to prevent strokes, he
said, but whether antiarrhythmics, drugs that affect heart rhythm, have any role
"remains an open question."
