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Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) and this arrhythmia is associated with increased morbidity and mortality in patients with AMI. Limited information is available, however, about changing, and contemporary, trends in the incidence and death rates associated with AF complicating AMI. We examined the magnitude and impact of AF and the risk of stroke and hospital and long-term death rates in a population-based study of patients hospitalized with AMI. The study population consisted of 7,513 residents of the Worcester, Massachusetts, metropolitan area hospitalized with AMI at all greater Worcester medical centers during 9 biennial years from 1990 to 2005. Overall incidence of AF complicating AMI was 13.3% and rates of AF increased during the most recent years under study. Patients who developed AF were at greater risk for acute stroke (adjusted odds ratio 2.25, 95% confidence interval 1.36 to 3.71) and dying during hospitalization (adjusted odds ratio 1.79, 95% confidence interval 1.46 to 2.19) compared with patients who did not develop AF during hospitalization for AMI. Postdischarge survival was significantly poorer in patients who developed AF. Odds of dying after AF did not change appreciably over the years under study. In conclusion, results of this study in residents of a large New England metropolitan area suggest that AF remains a frequent complication of AMI and is associated with a poor prognosis. Increased surveillance and targeted therapeutic approaches appear warranted for these high-risk patients. [Copyright &y& Elsevier]

Delay in seeking medical care after symptom onset in patients with an acute myocardial infarction (AMI) is related to increased morbidity and mortality. Duration of prehospital delay in patients hospitalized with AMI has not been well characterized over time, and potentially changing patient characteristics associated with prolonged delay are not well understood. The study sample consisted of 5,967 residents (mean age 76 years; 39% women) of the Worcester, Massachusetts, metropolitan area hospitalized with AMI in 11 annual periods from 1986 to 2005. Mean and median delay times have remained essentially unchanged during the past 2 decades. Mean and median prehospital delay times were 4.1 and 2.0 hours in 1986, 4.7 and 2.2 hours in 1995, and 4.6 and 2.0 hours in 2005, respectively. Approximately 45% of patients with AMI presented within 2 hours of acute symptom onset, whereas an additional one third presented from 2 to 6 hours after the onset of acute coronary symptoms. Advancing age and history of either diabetes or MI were associated with prolonged delay. Compared with patients arriving within 2 hours of symptom onset, those with prolonged prehospital delay were less likely to receive thrombolytic therapy and percutaneous coronary intervention within 90 minutes of hospital arrival. In conclusion, results of this population-based study suggest that a large proportion of patients with AMI continue to show prolonged prehospital delay. [Copyright &y& Elsevier]