March 6, 2000 (New York) -- Elderly people hospitalized for a major heart attack have a greater risk of dying if they develop atrial fibrillation, a disturbance of the heart's natural rhythm. In a study appearing in the March 7 issue of Circulation, researchers say more attention should be paid to this common complication, which occurred in 22% of the elderly people studied.
Atrial fibrillation (AF), which is the rapid, uncontrolled beating of the two upper chambers of the heart, affects more than 2 million Americans. Though AF is known to increase a person's future risk of death, the new study shows it to be a significant risk factor for death following a heart attack.
"We know that atrial fibrillation is a problem following [heart attack]," study co-author Allen J. Solomon, MD, tells WebMD. "Outside of [heart attack] we know that it is common in the elderly, but what was not clear was how common it was in elderly [heart attack] patients. In this study we found it to be even more common than suspected." Solomon is with the division of cardiology of Georgetown University Medical Center in Washington.
The authors evaluated more than 100,000 people 65 and older who were hospitalized with heart attacks.
AF, which occurred in close to a quarter of the study participants, was more likely in the older patients and those who had a history of heart disease. The patients with AF were more likely to have died while in the hospital -- 25% of them died, compared to 16% of those without the condition -- and up to 30 days after discharge. One year after their heart attacks, close to a half of the AF patients had died, compared to just under a third of the patients without AF.
The likelihood that atrial fibrillation will hurt recovery appears to depend on when it develops. Some studies have shown that only those who develop it while hospitalized are at increased risk of dying. Adding to the controversy, at least one large study found no connection between developing AF and dying after a heart attack.
"Various studies have said that atrial fibrillation is either an important risk factor for bad prognosis, or some have said it's not really a risk factor at all," Solomon says. His study found that though patients admitted to the hospital with AF had a small risk of death, those who developed it during hospitalization had a markedly increased risk.
Solomon says the next logical step is to determine the best treatment regimen for AF in these patients and to find ways to prevent it from occurring in concert with a heart attack. AF can be treated in a variety of ways, ranging from medications to surgery.
"We don't yet know for certain the best way to treat people once they have atrial fibrillation," Solomon says. "What we're looking at now is treating them more aggressively at the beginning, with the hope that less atrial fibrillation will develop. But we don't know for sure that that will work."
- Elderly patients who are in the hospital after having a heart attack are at higher risk of death if they develop atrial fibrillation, an abnormality in the heart rhythm, according to a recent study.
- Researchers found the atrial fibrillation in these patients was common, affecting one out of five elderly, hospitalized heart-attack patients.
- Some studies have shown no association between atrial fibrillation and death, while other research shows that the risk depends on when the patient develops the condition.