Temporal Trends and Outcomes Associated with Atrial Fibrillation Observed during Acute Coronary Syndrome: Real World Data from the Acute Coronary Syndrome Israeli Survey (ACSIS) 2000-2013

Aharon Erez ¹ Ilan Goldenberg ¹ Avi Sabbag ¹ Eyal Nof ¹ Doron Zahger ² Shaul Atar ³ Arthur Pollak ⁴ Idit Dobrecky-Mery ⁵ Roy Beigel ¹ Shlomi Matetzky ¹ Michael Glikson ¹ Roy Beinart ¹

¹Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
²Intensive Cardiac Care Unit, Department of Cardiology, Soroka University Medical Center, Be'er-Sheva, Israel
³Cardiology Department, Galilee Medical Center, Nahariya, Israel
⁴Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
⁵Department of Cardiology, Bnai Zion Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute ofTechnology, Haifa, Israel.

Background: Over the past decade there have been major advances in medical therapies and invasive interventions of patients presenting with acute coronary syndromes (ACS). The aim of the present study was to evaluate temporal trends in the incidence of atrial fibrillation (AF) and associated outcomes in ACS patients using nationwide real-life data.

Methods: We evaluated time-dependent changes in clinical characteristics, management strategies, and outcomes associated with AF observed during ACS hospitalization in patients who were enrolled in the biannual ACS Israeli Surveys (ACSIS) between 2000 and 2013. We divided the surveys into early (2000–2006) vs. late (2008–2013) periods.

Results: The study population comprised 13,297 ACS patients, of whom 755 (6%) either presented with or developed AF during the index hospitalization. The incidence of AF observed during ACS hospitalization was lower during the late period

(6. 2% vs. 4.9%, p < 0.01). Patients with AF had a significantly higher GRACE score compared with those without AF (239±57 vs. 195±46, p <0.001). Multivariate analysis showed that AF observed among ACS patients, was independently associated with increased risk for 1-year mortality throughout both survey periods (HR=1.7 and 1.4, respectively; p-value for AF-by-survey period interaction = 0.14).

Conclusions: Over the past decade there has been a significant decline in rates of AF among ACS patients. Yet, these patients are still at increased residual risk for long-term mortality that needs to be further addressed.