Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction. Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Atrial fibrillation and mortality in an elderly population. Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Atrial fibrillation and the risk of myocardial infarction. Predictive Value of P‐Wave Signal‐Averaged Electrocardiogram for Atrial Fibrillation in Acute Myocardial Infarction The association between atrial fibrillation and sudden cardiac death: the relevance of heart failure. Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Relationship of Sudden Cardiac Death to New-Onset Atrial Fibrillation in Hypertensive Patients With Left Ventricular Hypertrophy Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data Fibrinogen as a risk factor for stroke and myocardial infarction. Incidence of myocardial infarction and vascular death in elderly patients with atrial fibrillation taking anticoagulants: relation to atherosclerotic risk factors. Risk factors for thromboembolic stroke in elderly patients with chronic atrial fibrillation. Long-term cardiovascular outcomes in patients with atrial fibrillation and atherothrombosis in the REACH Registry. A longitudinal population-based study of prothrombotic factors in elderly subjects with atrial fibrillation: the Rotterdam Study 1990-1999. Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations: GISSI-Prevenzione mortality risk chart.
AIMS To characterize the relationship between known and newly diagnosed atrial fibrillation ( AF ) and the risk of death and major cardiovascular ( CV ) events in patients with acute myocardial infa rct ion ( MI ) complicated by heart failure ( HF ) and /or left ventricular systolic dysfunction ( LVSD ) . METHODS The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and /or LVSD .  AF was assessed at presentation and at r and omization ( median 4.9 days after symptom onset ) . Primary outcomes were risk of death and major CV events 3 years following acute MI . RESULTS A total of 1812 with current AF ( AF between presentation and r and omization ) , 339 patients with prior AF ( history of AF without current AF ) , and 12,509 without AF were enrolled . Patients with AF were older ; had more prior HF , angina , and MI , and received beta-blockers and thrombolytics less often than those without AF . Three-year mortality estimates were 20 % in those without AF , 37 % with current AF , and 38 % with prior AF . Compared with patients without AF , the multivariable adjusted HR of death was 1.25 ( 1.03 - 1.52 ; p=0.03 ) for prior AF and 1.32 ( 1.20 - 1.45 ; p<0.0001 ) for current AF . HR for major CV events was 1.15 ( 0.98 - 1.35 ; p=0.08 ) and 1.21 ( 1.12 - 1.31 ; p<0.0001 ) . CONCLUSION AF is associated with greater long-term mortality and adverse CV events with acute MI complicated by HF or LVSD AIMS Atrial fibrillation ( AF ) is a common complication in patients with acute myocardial infa rct ion and is associated with an increase in the risk of death . The excess mortality associated with AF complicating acute myocardial infa rct ion has not been studied in detail . Observations indicate that AF facilitates induction of ventricular arrhythmias , which may increase the risk of sudden cardiovascular death ( SCD ) . A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments . METHODS AND RESULTS We analysed the relation between AF/atrial flutter ( AFL )  and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infa rct ion screened in the TR And olapril Cardiac Evaluation registry . This cohort of patients with an enzyme-verified acute myocardial infa rct ion was admitted to 27 centres in 1990 - 92 .  Survival status was obtained 2 years after screening of the last patient . An independent endpoint committee assessed the modes of death . Left ventricular ejection fraction was determined in all the screened patients and information about presence or absence of AF/AFL was prospect ively collected . Sustained or paroxysmal AF/AFL was observed in 1149 patients ( 19 % ) during hospitalization . During follow-up , 1659 patients ( 34 % ) died : 482 ( 50 % ) patients with AF/AFL and 1177 ( 30 % ) patients without AF/AFL , P<0.001 . SCD occurred in 536 , non-SCD occurred in 725 , and 398 died of non-cardiovascular causes ( includes 142 unclassifiable cases ) . The adjusted risk ratio of AF/AFL for total mortality was 1.33 ( 95 % CI : 1.19 - 1.49 ; P<0.0001 ) and the risk ratio for SCD was 1.31 ( 95 % CI : 1.07 - 1.60 ; P<0.009 ) . The adjusted risk ratio of AF/AFL for non-SCD was 1.43 ( 95 % CI : 1.21 - 1.70 ; P<0.0001 ) . CONCLUSION The excess mortality observed in patients with AF/AFL following acute myocardial infa rct ion is due to a significant increase in both SCD and non-SCD BACKGROUND Atrial fibrillation ( AF ) or flutter occurring after myocardial infa rct ion may occur alone or in association with other complications . Whether the arrhythmia portends a poor prognosis independent of other complications with contemporary therapy is unknown . METHODS AND RESULTS As part of the Global Use of Strategies To Open occluded coronary arteries ( GUSTO-III ) trial , we evaluated whether postinfa rct ion complications were associated with the subsequent development of  AF  and whether AF independently predicted death over periods of 30 days and 1 year . Information including exact timing was collected on deaths and major in-hospital postinfa rct ion complications up to 30 days . Of the 13,858 patients with sinus rhythm at enrollment , 906 later had AF or flutter and 12 , 952 did not . We compared outcomes between these 2 groups , adjusting for differences in baseline characteristics and prefibrillation complications . Worsening heart failure , hypotension , third-degree heart block , and ventricular fibrillation were independent predictors of new-onset AF . The unadjusted odds ratio ( OR ) for death among patients with versus those without AF was 2.74 ( 95 % confidence interval [ 95 % CI ] , 2.56 - 3.34 ) . After adjusting for baseline differences , the OR was reduced to 1.63 ( 95 % CI , 1.31 - 2.02 ) . Adjustment for other in-hospital complications before the onset of AF further reduced the OR to 1.49 ( 95 % CI , 1.17 - 1.89 ) . CONCLUSIONS Atrial fibrillation or flutter occurs secondary to other postinfa rct ion complications but independently portends a worse prognosis . Prevention and management may improve outcome Prospect i ve data from Busselton , Western Australia , collected during triennial surveys from 1966 - 81 with follow-up of subjects to 1983 , showed that atrial fibrillation ( AF ) was frequent in elderly people and associated with increased mortality . Of 1770 people aged over 60 years , 40 were in atrial fibrillation when first seen and a further 47 developed it during follow-up . Atrial fibrillation was positively associated with angina , history of a myocardial infa rct ion and left bundle branch block . Relative mortality in those with atrial fibrillation compared with those without it , was 1.92 for all causes , 1.82 for death from cardiovascular causes ( excluding stroke ) and 3.78 for deaths from stroke , after adjustment by proportional hazards regression for confounding effects of age , sex , history of a myocardial infa rct ion , an abnormal electrocardiogram , angina , cholesterol level systolic blood pressure and Quetelet 's Index ( weight/height2 ) . The excess relative mortality declined with increasing age for both women and men . This raised relative mortality remained constant with time from the first detection of AF for all causes and cardiovascular causes but appeared to increase with time from detection for stroke death . The risk of death from stroke was greatest in the younger women . The observed risk of death from stroke in patients with AF suggests that anticoagulant use should be considered in selected patients BACKGROUND Atrial fibrillation ( AF ) is a major risk factor ( RF ) for ischemic stroke . Its prevalence and prognostic impact in patients with atherothrombosis are unclear . METHODS Risk factors , drug usage , and 1-year cardiovascular ( CV ) outcomes ( CV death , myocardial infa rct ion [ MI ] , and stroke ) were compared in  AF and non-AF patients from the REduction of Atherothrombosis for Continued Health ( REACH ) Registry , an international , prospect i ve cohort of 68,236 stable out patients with established atherothrombosis or > or=3 atherothrombotic RFs . RESULTS Atrial fibrillation and 1-year follow-up data are available for 63,589 patients . The prevalence of AF was , 12.5 % , 13.7 % , 11.5 % , and 6.2 % among coronary artery disease , CV disease , peripheral artery disease , and RF-only patients , respectively . Of the 6,814 patients with AF , 6.7 % experienced CV death , nonfatal MI , or nonfatal stroke within a year . The annual incidence of nonfatal stroke ( 2.4 % vs 1.6 % , P<.0001 ) and unstable angina ( 6.0 % vs 4.0 % , P<.00001 ) was higher , and CV death was more than double ( 3.2 % vs 1.4 % , P<.0001 ) , in AF versus non-AF patients . In these patients with or at high risk of atherothrombosis , most patients with AF received antiplatelet agents , but only 53.1 % were treated with oral anticoagulants . Even with high CHADS2 ( congestive heart failure , hypertension , aging , diabetes mellitus , and stroke ) scores , anticoagulant use did not exceed ( 59 % ) . The rate of bleeding requiring hospitalization was higher in AF versus non-AF patients ( 1.5 % vs 0.8 % , P<.0001 ) , possibly related to the more frequent use of anticoagulants ( 53.1 % vs 7.1 % ) . CONCLUSIONS Atrial fibrillation is common in patients with atherothrombosis , associated with more frequent fatal and nonfatal CV outcomes , and underuse of oral anticoagulants IMPORTANCE Myocardial infa rct ion ( MI ) is an established risk factor for  atrial fibrillation ( AF ) .  However , the extent to which AF is a risk factor for MI has not been investigated . OBJECTIVE To examine the risk of incident MI associated with AF . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve cohort of 23,928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke ( REGARDS ) cohort between 2003 and 2007 , with follow-up through December 2009 . MAIN OUTCOMES AND MEASURES Expert-adjudicated total MI events ( fatal and nonfatal ) . RESULTS Over 6.9 years of follow-up ( median 4.5 years ) , 648 incident MI events occurred . In a sociodemographic-adjusted model , AF was associated with about 2-fold increased risk of MI ( hazard ratio [ HR ] , 1.96 [ 95 % CI , 1.52 - 2.52 ] ) . This association remained significant ( HR , 1.70 [ 95 % CI , 1.26 - 2.30 ] ) after further adjustment for total cholesterol , high-density lipoprotein cholesterol , smoking status , systolic blood pressure , blood pressure-lowering drugs , body mass index , diabetes , warfarin use , aspirin use , statin use , history of stroke and vascular disease , estimated glomerular filtration rate , albumin to creatinine ratio , and C-reactive protein level . In subgroup analysis , the risk of MI associated with AF was significantly higher in women ( HR , 2.16 [ 95 % CI , 1.41 - 3.31 ] ) than in men ( HR , 1.39 [ 95 % CI , 0.91 - 2.10 ] ) and in blacks ( HR , 2.53 [ 95 % CI , 1.67 - 3.86 ] ) than in whites ( HR , 1.26 [ 95 % CI , 0.83 - 1.93 ] ) ; for interactions , P = .03 and P = .02 , respectively . On the other h and , there were no significant differences in the risk of MI associated with AF in older ( ≥75 years ) vs younger ( < 75 years ) participants ( HR , 2.00 [ 95 % CI , 1.16 - 3.35 ] and HR , 1.60 [ 95 % CI , 1.11 - 2.30 ] , respectively ) ; for interaction , P = .44 . CONCLUSIONS AND RELEVANCE AF is independently associated with an increased risk of incident MI , especially in women and blacks . These findings add to the growing concerns of the seriousness of AF as a public health burden : in addition to being a well-known risk factor for stroke , AF is also associated with increased risk of MI Background : Atrial fibrillation ( AF ) is a common complication of acute myocardial infa rct ion ( AMI ) with a reported incidence of 7–18 % . Recently ,  P‐wave signal‐averaged electrocardiogram ( P‐SAECG )  has been used to assess the risk of paroxysmal AF attacks in some diseases . The aim of this study was to determine prospect ively whether patients with AMI at risk for paroxysmal AF would be identified by P‐SAECG and other clinical variables OBJECTIVES The purpose of this study was to evaluate the role of congestive heart failure ( CHF ) in the association between  atrial fibrillation ( AF ) and sudden cardiac death ( SCD ) .  BACKGROUND Recent studies have reported the possibility of an independent association between AF and SCD . We hypothesized that a history of CHF is a significant confounder of this association . METHODS In a prospect i ve case-control analysis from the community ( The Oregon-SUDS [ Sudden Unexpected Death Study ] , 2002 to 2012 ) , SCD cases ( n = 652 ) with clinical records available ( including electrocardiography and /or echocardiography ) were compared with age- and sex-matched control patients with coronary artery disease . The association between AF and SCD was analyzed using multivariable logistic regression and propensity score matching . RESULTS Cases ( age 67.3 ± 11.7 years , 65 % male ) were more likely than control patients ( age 67.2 ± 11.4 years , 65 % male ) to have a history of AF ( p = 0.0001 ) , myocardial infa rct ion ( p = 0.007 ) , CHF ( p < 0.0001 ) , stroke ( p < 0.0001 ) , and diabetes ( p < 0.0001 ) . In multivariate analysis without considering CHF , AF was a significant predictor of SCD ( odds ratio [ OR ] : 1.6 ; 95 % confidence interval [ CI ] : 1.2 to 2.0 ; p = 0.002 ) . However , in a model that included CHF , the AF-SCD association was no longer significant ( OR : 1.1 ; 95 % CI : 0.8 to 1.5 ; p = 0.45 ) , whereas CHF was a significant predictor of SCD ( OR : 3.1 ; 95 % CI : 2.4 to 4.1 ; p < 0.0001 ) . Results on the basis of propensity score matching were consistent . CONCLUSIONS Our findings suggest that a history of CHF , including both systolic and diastolic symptomatic dysfunction , may partially explain the AF-SCD association The Canadian Cardiovascular Society ( CCS ) published the complete set of 2010 Atrial Fibrillation ( AF ) Guidelines in the January , 2011 issue of the Canadian Journal of Cardiology . During its deliberations , the CCS Guidelines Committee engaged to a timely review of future evidence , with periodic composition of focused up date s to address clinical ly important advances . In 2011 , results were published from 3 pivotal AF trials : the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation ( ROCKET-AF ) , the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation ( ARISTOTLE ) study , and the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of St and ard Therapy ( PALLAS ) , comparing dronedarone with placebo in patients with permanent AF and additional cardiovascular disease risk-factor burden . Each of these large r and omized trials provided clear results with major implication s for AF management . Other important evidence that has emerged since the 2010 Guidelines includes findings about prediction instruments for AF-associated stroke and bleeding risk , stroke risk in paroxysmal-AF patients , risk-benefit considerations related to oral anticoagulation in patients with chronic kidney disease , and risk/benefit considerations in the use of antiplatelet agents , alone and in combination with each other or with oral anticoagulants , in AF patients . The Guidelines Committee judged that this extensive and important new evidence required focused updating of the 2010 Guidelines with respect to stroke prevention and rate/rhythm control . This report presents the details of the new recommendations , along with the background and rationale Background —Prevalent atrial fibrillation ( AF ) is associated with a higher sudden cardiac death ( SCD ) rate in some population s , and incident AF predicts increased mortality risk in the general population and after myocardial infa rct ion . However , the relationship of SCD to new-onset AF is unclear . Methods and Results —The relationship of SCD to new-onset AF was evaluated in 8831 hypertensive patients with electrocardiographic left ventricular hypertrophy with no history of AF , in sinus rhythm on their baseline electrocardiogram , r and omly assigned to losartan- or atenolol-based treatment . During 4.7±1.1 years mean follow-up , new-onset AF occurred in 701 patients ( 7.9 % ) and SCD in 151 patients ( 1.7 % ) . In univariate Cox analyses , new-onset AF was associated with a > 4-fold higher risk of SCD ( hazard ratio , 4.69 ; 95 % CI interval , 2.96–7.45 ; P<0.001 ) . In multivariate Cox analyses adjusting for age , sex , race , diabetes mellitus , history of heart failure , myocardial infa rct ion , ischemic heart disease , stroke , smoking , serum high-density lipoprotein cholesterol , creatinine , glucose , and urine albumin/creatinine ratio as st and ard risk factors , and for incident myocardial infa rct ion , in-treatment use of digoxin , systolic and diastolic pressure , heart rate , QRS duration , Cornell voltage- duration product , and Sokolow-Lyon voltage left ventricular hypertrophy treated as time-varying covariates , new-onset AF remained associated with a > 3-fold increased risk of SCD ( hazard ratio , 3.13 ; 95 % confidence interval , 1.87–5.24 ; P<0.001 ) . Conclusions —Development of new-onset AF identifies hypertensive patients at  increased risk of SCD . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00338260 BACKGROUND Atrial fibrillation is the most common supraventricular arrhythmia in patients with acute myocardial infa rct ion . Recent advances in pharmacological treatment of myocardial infa rct ion may have changed the impact of this arrhythmia . OBJECTIVE To assess the incidence and prognosis of atrial fibrillation complicating myocardial infa rct ion in a large population of patients receiving optimal treatment , including angiotensin converting enzyme ( ACE ) inhibitors .  METHODS Data were derived from the GISSI-3 trial , which included 17 944 patients within the first 24 hours after acute myocardial infa rct ion . Atrial fibrillation was recorded during the hospital stay , and follow up visits were planned at six weeks and six months . Survival of the patients at four years was assessed through census offices . RESULTS The incidence of in-hospital atrial fibrillation or flutter was 7.8 % . Atrial fibrillation was associated with indicators of a worse prognosis ( age > 70 years , female sex , higher Killip class , previous myocardial infa rct ion , treated hypertension , high systolic blood pressure at entry , insulin dependent diabetes , signs or symptoms of heart failure ) and with some adverse clinical events ( reinfa rct ion , sustained ventricular tachycardia , ventricular fibrillation ) . After adjustment for other prognostic factors , atrial fibrillation remained an independent predictor of increased in-hospital mortality : 12.6%v 5 % , adjusted relative risk ( RR ) 1.98 , 95 % confidence interval ( CI ) 1.67 to 2.34 . Data on long term mortality ( four years after acute myocardial infa rct ion ) confirmed the persistent negative influence of atrial fibrillation ( RR 1.78 , 95 % CI 1.60 to 1.99 ) . CONCLUSIONS Atrial fibrillation is an indicator of worse prognosis after acute myocardial infa rct ion , both in the short term and in the long term , even in an unselected population To study the possible risk factors for cardiovascular disease , we collected data on plasma levels of coagulation factors , blood pressure , serum cholesterol , and smoking  in a r and om sample of 792 men 54 years of age . During 13.5 years of follow-up , myocardial infa rct ion occurred in 92 men , stroke in 37 , and death from causes other than myocardial infa rct ion or stroke in 60 . The blood pressure , degree of smoking , serum cholesterol , and fibrinogen level measured at the base-line examination proved to be significant risk factors for infa rct ion by univariate analyses during follow-up , and blood pressure and fibrinogen were risk factors for stroke . Fibrinogen and smoking were strongly related to each other . The relation between fibrinogen and infa rct ion , and between fibrinogen and stroke , became weaker when blood pressure , serum cholesterol , and smoking habits were taken into account , but was still significant for stroke . Although causality can not be inferred from these data , it is possible that the fibrinogen level plays an important part in the development of stroke and myocardial infa rct ion BACKGROUND Recent findings suggest that patients with atrial fibrillation ( AF ) , in addition being at thromboembolic risk , are at risk of myocardial infa rct ion ( MI ) . Our aim was to investigate predictors of MI and cardiovascular death in a cohort of patients with AF who were taking anticoagulants .  METHODS We prospect ively followed up 1,019 patients with AF for a median of 33.7 months ( 3,223 person-years ) . All patients were treated with oral vitamin K antagonists . Primary outcome was a composite end point of cardiovascular events ( CVEs ) including fatal/nonfatal MI , cardiac revascularization , and cardiovascular death . RESULTS The mean age of the patients was 73.2 years , and 43.8 % were women . At follow-up , 111 CVEs ( 3.43%/y ) had occurred : 47 fatal-nonfatal MI/revascularization and 64 cardiovascular deaths . In addition , 31 stroke/transient ischemic attacks ( 0.96%/y ) were recorded . Patients experiencing CVEs were older ( P < .001 ) and had a higher prevalence of metabolic syndrome ( MetS ) ( P = .005 ) , heart failure ( P = .001 ) , and prior cardiac ( P < .001 ) and cerebrovascular events ( P < .001 ) . On a Cox proportional hazard analysis , age ( hazard ratio [ HR ] , 1.083 ; 95 % CI , 1.053 - 1.113 ; P < .001 ) , smoking ( HR , 2.158 ; 95 % CI , 1.193 - 3.901 ; P = .011 ) , history of cerebrovascular ( HR , 1.704 ; 95 % CI , 1.119 - 2.597 ; P = .013 ) and cardiac ( HR , 1.658 ; 95 % CI , 1.105 - 2.489 ; P = .015 ) events , MetS ( HR , 1.663 ; 95 % CI , 1.107 - 2.499 ; P = .014 ) , heart failure ( HR , 1.584 ; 95 % CI , 1.021 - 2.456 ; P = .040 ) , and male sex ( HR , 1.499 ; 95 % CI , 1.010 - 2.223 ; P = .044 ) predicted CVEs . CONCLUSIONS Patients with AF still experience a high rate of CVEs despite receiving anticoagulant treatment . MetS is a common clinical feature in patients with AF , which increases the risk of CVEs . A holistic approach is needed to reduce the cardiovascular risk in patients with AF . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT01882114 ; URL : www . clinical trials.gov Abstract Chronic atrial fibrillation ( AF ) in the presence or absence of rheumatic valvular heart disease is associated with an increased incidence of stroke . 1,2 We reported in a prospect i ve study that at 27-month follow-up , echocardiographic left ventricular ( LV ) hypertrophy in elderly patients with systolic or diastolic hypertension was associated with an increased incidence of new atherothrombotic brain infa rct ion . 3 We also demonstrated in a prospect i ve study that at 3-year follow-up , risk factors for atherothrombotic brain infa rct ion were cigarette smoking , systolic or diastolic hypertension and diabetes mellitus in elderly men and systolic or diastolic hypertension , diabetes mellitus and obesity in elderly women . 4 This report correlates in elderly patients with chronic AF the prevalence of thromboembolic ( TE ) stroke with the presence or absence of rheumatic mitral stenosis , mitral anular calcium , valvular aortic stenosis , systolic or diastolic hypertension , prior myocardial infa rct ion , left atrial enlargement and LV hypertrophy BACKGROUND Patients with atrial fibrillation ( AF )  are at increased risk of thromboembolic events . The long-term prognostic implication s of AF in patients with atherothrombosis are unknown . METHODS We compared 4-year CV outcomes in patients with and without a history of AF recorded at their baseline visit in the REACH Registry , an international , prospect i ve cohort of patients with established atherosclerotic arterial disease ( CAD , CVD , PAD ) or at least 3 risk factors ( RFO ) . RESULTS AF status and 4 year follow-up data were available on 44,518 patients . The prevalence of AF at baseline was 10.3 % ( n=4582 ) . Overall , patients with AF had approximately a 2-fold increase in the composite of CV death , MI , or stroke compared with patients without AF after adjustment for age , gender , prior ischemic event , vascular disease , congestive heart failure , diabetes , smoking , body mass index , region , aspirin and statin use ( 18.9 % vs. 9.4 % , p<0.0001 ) . This increased risk was observed both in patients with established atherothrombosis ( CAD : 15.5 % vs. 8.0 % , p=0.0001 ; CVD : 23.6 % vs. 13.6 % , p<0.0001 ; PAD : 24.3 % vs. 13.5 % , p=0.089 ) and those with multiple risk factors ( RFO : 12.1 % vs. 5.9 % , p=0.017 ) . Only 52 % of patients with a history of AF at baseline were receiving anticoagulation at 4 years . CONCLUSIONS Patients with a history of both AF and atherothrombosis have particularly high long-term CV risk . Despite this increased risk , almost half of all patients with AF do not receive guideline recommended anticoagulation , highlighting an important public health priority BACKGROUND A prothrombotic or hypercoagulable state in atrial fibrillation may contribute to stroke and thromboembolism . Results of longitudinal population -based studies in elderly people with atrial fibrillation are not yet available . METHODS In the Rotterdam Study , a population -based prospect i ve cohort study , 162 participants with atrial fibrillation at baseline , aged 55 years and over , were matched for age and gender with 324 people in sinus rhythm . Associations were examined between three coagulation factors and the risk of total and cardiac mortality and stroke . Hazard rate ratios were calculated with 95 % confidence intervals using Cox 's proportional hazards model , adjusted for potential confounders . RESULTS Plasma von Willebr and factor was , age- and gender-adjusted , associated with cardiac mortality in the total population ( relative risk 1.16 ; 1.06 - 1.27 , per 10 IU dL(-1 ) increase ) , but statistical significance was lost after additional adjustments . A strong association ( 1.27 ; 1.08 - 1.50 , per 5-unit increase ) was found between soluble P-selectin ( sP-sel ) and cardiac mortality in atrial fibrillation patients but not in participants in sinus rhythm . Furthermore , the expected association between fibrinogen and cardiac mortality was observed only in those in sinus rhythm ( 2.60 ; 1.69 - 4.01 , per unit increase ) , and not in atrial fibrillation . No associations were found between coagulation factors and stroke . CONCLUSIONS In this population -based study , plasma levels of sP-sel predicted clinical adverse outcomes in atrial fibrillation , suggesting a role of platelets in the prothrombotic state associated with atrial fibrillation . Fibrinogen was a risk factor of cardiac and all-cause mortality in sinus rhythm , but not in atrial fibrillation AIMS To present and discuss a comprehensive and ready to use prediction model of risk of death after myocardial infa rct ion based on the very recently concluded follow-up of the large GISSI-Prevenzione cohort and on the integrated evaluation of different categories of risk factors : those that are non-modifiable , and those related to lifestyles , co-morbidity , background , and other conventional clinical complications produced by the index myocardial infa rct ion . METHODS The 11 - 324 men and women recruited in the study within 3 months from their index myocardial infa rct ion have been followed-up to 4 years . The following risk factors have been used in a Cox proportional hazards model : non-modifiable risk factors : age and sex ; complications after myocardial infa rct ion : indicators of left ventricular dysfunction ( signs or symptoms of acute left ventricular failure during hospitalization , ejection fraction , NYHA class and extent of ventricular asynergy at echocardiography ) , indicators of electrical instability ( number of premature ventricular beats per hour , sustained or repetitive arrhythmias during 24-h Holter monitoring ) , indicators of residual ischaemia ( spontaneous angina pectoris after myocardial infa rct ion , Canadian Angina Classification class , and exercise testing results ) ; cardiovascular risk factors : smoking habits , history of diabetes mellitus and arterial hypertension , systolic and diastolic blood pressure , blood total and HDL cholesterol , triglycerides , fibrinogen , leukocytes count , intermittent claudication , and heart rate . Multiple regression modelling was assessed by receiver operating characteristic ( ROC ) analysis . Generalizability of the models was assessed through cross validation and bootstrapping techniques . POPULATION AND RESULTS During the 4 years of follow-up , a total of 1071 patients died . Age and left ventricular dysfunction were the most relevant predictors of death . Because of pharmacological treatments , total blood cholesterol , triglycerides , and blood pressure values were not significantly associated with prognosis . Sex-specific prediction equations were formulated to predict risk of death according to age , simple indicators of left ventricular dysfunction , electrical instability , and residual ischaemia along with the following cardiovascular risk factors : smoking habits , history of diabetes mellitus and arterial hypertension , blood HDL cholesterol , fibrinogen , leukocyte count , intermittent claudication , and heart rate . The predictive models produced on the basis of information available in the routine conditions of clinical care after myocardial infa rct ion provide ready to use and highly discriminant criteria to guide secondary prevention strategies . CONCLUSIONS AND IMPLICATION S Besides documenting what should be the preferred and practicable focus of clinical attention for today 's patients , the experience of GISSI-Prevenzione suggests that periodically and prospect ively collected data bases on naturalistic ' cohorts could be an important option for updating and verifying the impact of guidelines , which should incorporate the different components of the complex profile of cardiovascular risk . The GISSI Prevenzione risk function is a simple tool to predict risk of death and to improve clinical management of subjects with recent myocardial infa rct ion . The use of predictive risk algorithms can favour the shift from medical logic , based on the treatment of single risk factors , to one centred on the patient as a whole as well as the tailoring of medical interventions according to patients ' overall risk
These results showed that AF is an independent risk factor for MI , CV death , and CV events
This study aim ed to investigate whether  atrial fibrillation ( AF ) predicts myocardial infa rct ion ( MI ) or cardiovascular ( CV ) death .
AF is a well-established risk factor for thrombotic stroke and all-cause mortality .