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Resumo Fundamento A ecocardiografia é essencial para o diagnóstico e a quantificação da insuficiência aórtica (IA). A integral velocidade-tempo (IVT) do fluxo da IA pode estar relacionada à gravidade da IA. Objetivo Este estudo tem por objetivo avaliar se a IVT é um marcador ecocardiográfico de gravidade da IA. Métodos Foram incluídos todos os pacientes com IA nativa moderada ou grave e ritmo sinusal que visitaram o nosso laboratório de imagem entre janeiro e outubro de 2016. Todos os indivíduos foram submetidos a um ecocardiograma completo com medição da IVT da IA. A associação entre a IVT e a gravidade da IA foi analisada por regressão logística e modelos de regressão multivariada. Valores p

Background. Anticoagulation with vitamin K antagonists continues to be a challenging task given the difficulty of achieving a correct time in therapeutic range (TTR). The SAMeTT2R2 score has been proposed to identify patients that will be good responders. In this study we aimed to analyse clinical and genetic factors involved in a correct level of anticoagulation in patients with atrial fibrillation and thereby potentially improve the diagnostic performance of SAMeTT2R2 score. Methods. We prospectively included 212 consecutive patients with nonvalvular atrial fibrillation under treatment with acenocoumarol for at least 6 months that were attended in a cardiology outpatient clinic and were categorized as adherent to medication. We carried out a multivariate regression analysis to detect the independent predictive factors of good control. In all patients VKORC1, CYP2C9⁎2, CYP2C9⁎3, and MIR133A2 genotyping was performed. Results. A total of 128 (60.4%) patients presented TTR 2R2 score (C-statistic 0.658 versus 0.524, p Conclusions. In our study the SAMeTT2R2 score revealed a poor ability in the prediction of TTR. Besides SAMeTT2R2, body mass index and possibly vitamin K intake should be taken into account when deciding the optimal anticoagulation strategy. The information provided by the identified genotypes was marginal.

BACKGROUND Blood pressure variability (BPV) has been postulated as a potential predictor of cardiovascular outcomes. No agreement exists as to which measurement method is best for BPV estimation. We attempt to assess the correlation between BPV obtained at the doctor’s office, self-measurement at home (SMBP) and ambulatory BP monitoring (ABPM). METHODS Eight weekly clinic BP measurements, 2 SMBP series, and 1 24-hour ABPM recording were carried out in a sample of treated hypertensive patients. BPV was calculated using the SD, the “coefficient of variation” and the “average real variability.” Determinants of short-, mid-, and long-term BPV (within each measurement method) were also calculated. The different BPV determinants were correlated “intramethod” and “intermethod” by linear regression test. RESULTS For the 104 patients (66.5 ± 7.7 years, 58.7% males), the ABPM BPV (SD, systolic/diastolic: 14.5 ± 3.1/9.8 ± 2.5 mm Hg) was higher than the SMBP (12.2 ± 9.8/7.4 ± 5.8 mm Hg; P < 0.001) and clinic BPV (10 ± 8.9/5.9 ± 4.9 mm Hg; P = 0.001). The main BPV correlation between methods was weak, with a maximum R2 = 0.17 (P < 0.001) between clinic and SMBP systolic BPV. The “intramethod” correlation of BPV yielded a maximum R2 = 0.21 (P < 0.001) between morning diastolic SMBP intershift/intermeans variability. The “intermethod” correlation of short-, mid-, and long-term BPV determinants was weak (maximum R2 = 0.22, P < 0.001, between clinic intraday variability/SMBP morning intershift variability). CONCLUSIONS The “intramethod” and “intermethod” correlation between BPV determinants was weak or nonexistent, even when comparing determinants reflecting the same type of temporal BPV. Our data suggest that BPV reflects a heterogeneous phenomenon that strongly depends on the estimation method and the time period evaluated.

Resumen Introduccion y objetivos Estudios poblacionales llevados a cabo en otros paises indican una disminucion de las tasas estandarizadas de hospitalizacion por insuficiencia cardiaca (IC); sin embargo, en Espana se carece de datos poblacionales. Metodos A partir del Conjunto Minimo Basico de Datos de todos los hospitales de la Region de Murcia, se obtuvieron los episodios asistenciales por tarjeta sanitaria individual con un diagnostico principal de IC entre 2003-2013 (n = 27.158). Para cada ano se estudiaron las tasas de hospitalizacion por 1.000 habitantes (‰), bruta y estandarizada por edad y sexo, variables clinicas y administrativas. Las tendencias temporales se analizaron con regresion de joinpoint. Resultados La tasa de hospitalizacion aumento un 76,7%, pasando del 1,28 a 2,26‰ (bruta) y del 1,06 a 1,77‰ (estandarizada); el porcentaje de cambio anual medio (PCA) fue 8,2% hasta 2007 y posteriormente 1,9% (p 6 puntos se duplicaron. La estancia y mortalidad hospitalarias no cambiaron. Conclusiones Entre 2003-2013 persiste un incremento sostenido de la hospitalizacion por IC, que afecta a la poblacion ≥ 75 anos y esta asociado al aumento de comorbilidad. Son necesarias estrategias especificas dirigidas a esta poblacion.

Objective: To evaluate the contribution of six polymorphisms to the platelet reactivity in patients with acute coronary syndrome (ACS) treated with clopidogrel. Methods: Cross-sectional study of 278 consecutive patients with ACS. Detailed clinical information for each patient was collected and genotypes (CYP2C9*2, CYP2C9*3, CYP2C19*2, CYP2C19*17, CYP3A4*1B, and PON1-Q192R) were evaluated with TaqMan® and KASPar® assays. Platelet reactivity was measured with VerifyNow®. Results: Mean age of patients was 66±11 years and 182 (65.5%) patients presented ACS without ST-segment elevation. A total of 206 (74.1%) patients presented poor response to clopidogrel (PRC). CYP2C19*2 polymorphism (p=0.038) was associated with PRC in the univariate setting. In the multiple logistic regression analysis, the risk factors for PRC were the presence of CYP3A4*1B allele (odds ratio [OR] 4.03; 95% confidence interval [CI] 1.01–16.34), age (OR 1.43; 95% CI 1.03–2.00), and body mass index (OR 4.05; 95% CI 1.21–13.43), whereas elevated hemoglobin was a protective factor. Discrimination of PRC through the model that included the six polymorphisms added modest information to the model based on clinical variables (C statistic difference 3.9%). Conclusion: CYP3A4*1B allele may be an independent determinant of PRC in patients with ACS, although the variability in response to clopidogrel explained by the six polymorphisms is poor when compared to clinical variables. (Anatol J Cardiol 2017; 17: 303-12)

La enfermedad cardiovascular es la afeccion cronica grave mas prevalente en los paises industrializados y esta aumentando rapidamente. Tiene un caracter multisistemico, y con frecuencia afecta a varios lechos vasculares a la vez. El espectro clinico del paciente en riesgo comprende desde el individuo con factores de riesgo hasta el paciente con sindromes vasculares agudos, pasando por el paciente con eventos remotos. La aplicacion indiscriminada de metodos de diagnostico en poblacion asintomatica de baja-intermedia prevalencia conlleva con frecuencia mas morbilidad de la que se pretende evitar y esto es asi sobre todo cuando hablamos de criba de la enfermedad cerebrovascular. Precisamos de algoritmos que incorporen los datos clinicos y la informacion proporcionada por nuevas tecnologias a un coste razonable para que seamos capaces de realizar una deteccion coste-eficaz de enfermedad cerebrovascular severa que se pueda beneficiar de una intervencion precoz en la fase asintomatica de la enfermedad.

Coronary blood flow measurement using a Doppler guidewire is the most sensitive way of detecting the no-reflow phenomenon following reperfusion of a myocardial infarction (MI). New high-frequency Doppler probes enable coronary blood flow velocity to be measured noninvasively. Our aims were to study the different patterns of left anterior coronary artery blood flow observed by transthoracic Doppler echocardiography, and to describe their association with functional recovery following reperfusion of an anterior MI.The study included 57 patients with a mean age of 60 years (range 30-85 years). An abnormal coronary blo:d flow pattern was defined as one in which there was a high peak diastolic velocity and a short deceleration time (i.e.,or = 500 ms). We compared the regional contractility, ventricular volumes, and left ventricular ejection fraction (LVEF) measured after 72 hours with those measured 1 month after MI.Overall, 31 patients (54%) had a normal coronary blood flow pattern (Group 1) and 26 (46%), an abnormal pattern (Group 2). After one month, regional contractility improved in Group-1 patients, as did LVEF, from 46.8 (8.6) to 52.6 (8.8)% (P=.002). In these patients, left ventricular volumes were unchanged. In contrast, regional contractility and LVEF remained unchanged in Group-2 patients whereas ventricular volumes increased, from 55.8 (12.9) to 62.9 (16.8) ml/m2 (P=.05), and from 32.2 (9.5) to 37.1 (14.9) ml/m2 (P.05). Coronary blood flow pattern was the most important independent predictor of left ventricular remodeling, odds ratio =6.14 (95% CI, 1.56-24.17).Transthoracic Doppler echocardiographic assessment of coronary blood flow following reperfusion of an anterior myocardial infarction can be used to identify patients with microvascular damage who are progressing towards ventricular dilatation without recovery of myocardial function.

Introduccion y objetivos El metodo mas eficaz para detectar el fenomeno de «no reflujo» tras el infarto de miocardio revascularizado es el estudio del flujo mediante guias de Doppler intracoronario. La incorporacion de sondas Doppler de alta frecuencia permite evaluar el flujo coronario de forma no invasiva. El objetivo es describir diferentes patrones de flujo coronario mediante Doppler transtoracico y estudiar sus asociaciones con la recuperacion funcional del tejido infartado. Metodos Estudiamos a 57 pacientes de 60 anos de edad (rango, 30-85). Describimos un flujo coronario anomalo al caracterizado por onda diastolica de elevada velocidad con tiempo de deceleracion rapido (≤ 500 ms). Comparamos la contractilidad regional, los volumenes ventriculares y la fraccion de eyeccion del ventriculo izquierdo (FEVI) de los pacientes a las 72 h y al mes del episodio agudo. Resultados En total, 31 pacientes (54%) presentaban un flujo normal (grupo 1) y 26 (46%), un flujo anomalo (grupo 2). Al mes de seguimiento, en los pacientes del grupo 1 mejoro tanto la contractilidad regional como la FEVI (el 46,8 ± 8,6 frente al 52,6 ± 8,8%; p = 0,002), sin aumento en los volumenes ventriculares. Por el contrario, los pacientes del grupo 2 no experimentaron mejoria en la contractilidad regional ni en la FEVI aumentando sus volumenes ventriculares de 55,8 ± 12,9 a 62,9 ± 16,8 ml/m 2 (p = 0,05) y de 32,2 ± 9,5 a 37,1 ± 14,9 ml/m 2 (p odds ratio = 6,14; intervalo de confianza del 95%, 1,56-24,17). Conclusiones El estudio del flujo coronario mediante Doppler transtoracico permite identificar a los pacientes con dano microvascular que tras un infarto anterior evolucionaran hacia la dilatacion ventricular sin recuperacion de la funcion regional de la zona infartada.

En el presente articulo se revisan las principales novedades en el campo de la hipertension arterial publicadas en el ultimo ano. Abarcan desde aspectos muy polemicos, como ha sido la diferente orientacion diagnostica y terapeutica entre las principales guias de las sociedades americana y europea, la emergente importancia del binomio hipertension arterial y sindrome de apnea obstructive del sueno y, finalmente, los resultados de los principales estudios publicados durante el ano 2005.

En la presente revision se analizan los avances mas relevantes publicados durante el ultimo ano en el campo de la hipertension arterial (HTA), prestando un especial interes a los ultimos ensayos clinicos que vienen a confirmar un concepto clasico ya conocido, en el que lo mas importante en el tratamiento del paciente hipertenso es conseguir el control de las cifras de presion arterial y que, unicamente cuando ello se ha alcanzado, se ponen de manifiesto los efectos beneficiosos adicionales de determinados grupos terapeuticos antihipertensivos, como son los farmacos que bloquean el eje renina-angiotensina-aldosterona. Asimismo, se analiza la informacion pronostica que nos aporta un procedimiento tan sencillo e incruento como es el indice tobillo-brazo en la valoracion cardiovascular de los pacientes, sin olvidar la importancia creciente del hiperaldosteronismo primario como etiologia de la HTA. Finalmente, se remarcan los aspectos mas novedosos publicados respecto de la asociacion entre la diabetes y la HTA y los efectos potenciales del bloqueo del receptor activador de la proliferacion de peroxisomas gamma en la prevencion cardiovascular.

Introduction and objectives. Differences between anatomical severity and clinical manifestations are frequent in patients with hypertrophic cardiomyopathy. Our objective was to assess functional capacity in a consecutive group of patients with hypertrophic cardiomyopathy measuring exercise aerobic parameters, as well as clinical and echocardiographic variables. Patients and method. We studied 98 consecutive patients with hypertrophic cardiomyopathy. All patients underwent both echocardiographic and cardiopulmonary exercise testing. The control group consisted of 22 untrained persons. We studied exercise capacity by analyzing maximal oxygen consumption and aerobic functional capacity, among other variables. Results. Patients with hypertrophic cardiomyopathy attained significantly lower maximal oxygen consumption values than controls (24.1 ± 5.9 vs 36.4 ± 5.9 ml/kg/min; p = 0.0001). Maximal aerobic capacity was significantly different among patients with NYHA functional capacity class I, II or III (78.9 ± 13.5%; 71.9 ± 14.7%; 63.9 ± 15.7%; p = 0.009). However, considerable overlap was found between groups in maximal aerobic capacity. Functional impairment was greater in patients with left ventricular thickness > 20 mm, ejection fraction 45 mm and pseudonormal or restrictive transmitral flow pattern. Conclusions. Patients with hypertrophic cardiomyopathy show significant functional impairment, which is difficult to detect from their clinical manifestations. Optimal assessment requires cardiopulmonary exercise testing.

Introduction. We evaluated the feasibility of detecting blood flow in the left anterior descending coronary artery and the usefulness of measuring coronary flow reserve to diagnose significant coronary artery disease, both by means of transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent. Patients and method. We studied 107 patients who were scheduled for coronary arteriography for known or suspected ischemic heart disease. A Doppler signal was recorded by a pulsed wave in the distal left anterior descending artery at baseline and after dipyridamole infusion. An echo-contrast agent was administered to all patients. A coronary flow reserve equal to or higher than 1.7 was considered normal. Results. We recorded Doppler signals in the left anterior descending coronary artery of 83 patients (78%). Significant stenosis of the left anterior descending coronary artery was observed in 24 out of 83 patients (29%). The prevalence of significant stenosis was higher (62 vs 29%; p = 0.006) in patients in which no Doppler signal was detected. The sensitivity, specificity, and accuracy of abnormal coronary flow reserve in detecting significant stenosis of the left anterior descending coronary artery were 87, 74 and 78%, respectively. Conclusions. The measurement of coronary flow reserve by transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent is a feasible, widely available, and accurate method for detecting significant stenosis of the left anterior descending coronary artery.

Desde la elaboracion de las guias de practica clinica en hipertension arterial en enero del ano 2000 se han producido nuevas evidencias cientificas que hay que tener en cuenta en el ambito de la practica clinica. Es necesario realizar la evaluacion clinica del hipertenso mediante la estratificacion de su riesgo cardiovascular global, en la que los datos aportados por el electrocardiograma (ECG) y el analisis de orina (deteccion de excrecion urinaria de albumina) son de especial relevancia. Hasta la actualidad, los resultados de multiples estudios disponibles indican que en la hipertension arterial lo mas importante es normalizar los valores de la presion arterial, con un control mas estricto en los hipertensos de mayor riesgo (diabeticos, lesion de organo diana y enfermedad cardiovascular asociada). La individualizacion del tratamiento constituye la base de la eleccion de farmacos antihipertensivos. Sin embargo, debe tenerse en cuenta que los hipertensos con ciertas enfermedades asociadas obtienen un mayor beneficio de determinados grupos farmacologicos. Los hipertensos diabeticos o con hipertrofia ventricular izquierda parecen beneficiarse del bloqueo farmacologico del sistema renina-angiotensina y los pacientes con insuficiencia cardiaca deben recibir tratamiento combinado con inhibidores de la enzima de conversion de la angiotensina (IECA) y bloqueadores beta.

Introduction. The Influence of diabetes mellitus in the late outcome of coronary stenting remains controversial. Aim. The aim of this study was to determine the late clinical outcome of diabetics in comparison with non diabetics and to establish whether there are subgroups of diabetic patients with a greater need for target lesion revascularization.

La hipertension arterial es un factor de riesgo cardiovascular reconocido, responsable de una morbimortalidad cardiovascular elevada. Sin embargo, a pesar de disponer de farmacos eficaces para su tratamiento y de numerosos programas cientificos de formacion y actualizacion realizados, la realidad es que solo se controla a un porcentaje bajo de pacientes de acuerdo con las cifras consideradas normales en la actualidad. La publicacion de estas normas o guias de actuacion en hipertension arterial tiene el objetivo de que sirvan de orientacion a los medicos que tratan a pacientes con hipertension arterial y lograr su mejor diagnostico, tratamiento y control. Los factores que inciden en las complicaciones cardiovasculares en el paciente hipertenso son multifactoriales, por lo que se resalta la importancia de la estratificacion del riesgo cardiovascular individual, para establecer la estrategia terapeutica y de actuacion general. La informacion obtenida de los ultimos estudios publicados ha confirmado el interes de lograr el mayor descenso posible de la cifras de presion arterial, sobre todo en los subgrupos de mayor riesgo. Se mantiene la necesidad de implantar las medidas no farmacologicas o de cambios de estilo de vida en todos los pacientes con hipertension arterial, necesiten o no tratamiento farmacologico. Todos los grupos farmacologicos pueden ser utilizados, eligiendo el que se adapte mejor a las caracteristicas individuales de cada paciente, impulsando la utilizacion de dosis bajas inicialmente y el empleo de combinaciones de farmacos.

The following article reviews some of the most recent data that have come to light in the field of hypertension during the last year, including the long lasting controversy USA/Europe on the definition and treatment of hypertension, the importance of the interrelationship hypertension/sleep apnea syndrome, to conclude by discussing some of the most compelling implications of the main trials that have been published during the last few months.

Differences between anatomical severity and clinical manifestations are frequent in patients with hypertrophic cardiomyopathy. Our objective was to assess functional capacity in a consecutive group of patients with hypertrophic cardiomyopathy measuring exercise aerobic parameters, as well as clinical and echocardiographic variables.We studied 98 consecutive patients with hypertrophic cardiomyopathy. All patients underwent both echocardiographic and cardiopulmonary exercise testing. The control group consisted of 22 untrained persons. We studied exercise capacity by analyzing maximal oxygen consumption and aerobic functional capacity, among other variables.Patients with hypertrophic cardiomyopathy attained significantly lower maximal oxygen consumption values than controls (24.1 5.9 vs 36.4 5.9 ml/kg/min; p = 0.0001). Maximal aerobic capacity was significantly different among patients with NYHA functional capacity class I, II or III (78.9 13.5%; 71.9 14.7%; 63.9 15.7%; p = 0.009). However, considerable overlap was found between groups in maximal aerobic capacity. Functional impairment was greater in patients with left ventricular thickness20 mm, ejection fraction50%, left atrial dimension45 mm and pseudonormal or restrictive transmitral flow pattern.Patients with hypertrophic cardiomyopathy show significant functional impairment, which is difficult to detect from their clinical manifestations. Optimal assessment requires cardiopulmonary exercise testing.

We evaluated the feasibility of detecting blood flow in the left anterior descending coronary artery and the usefulness of measuring coronary flow reserve to diagnose significant coronary artery disease, both by means of transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent.We studied 107 patients who were scheduled for coronary arteriography for known or suspected ischemic heart disease. A Doppler signal was recorded by a pulsed wave in the distal left anterior descending artery at baseline and after dipyridamole infusion. An echo-contrast agent was administered to all patients. A coronary flow reserve equal to or higher than 1.7 was considered normal.We recorded Doppler signals in the left anterior descending coronary artery of 83 patients (78%). Significant stenosis of the left anterior descending coronary artery was observed in 24 out of 83 patients (29%). The prevalence of significant stenosis was higher (62 vs 29%; p = 0.006) in patients in which no Doppler signal was detected. The sensitivity, specificity, and accuracy of abnormal coronary flow reserve in detecting significant stenosis of the left anterior descending coronary artery were 87, 74 and 78%, respectively.The measurement of coronary flow reserve by transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent is a feasible, widely available, and accurate method for detecting significant stenosis of the left anterior descending coronary artery.

Since publication of the Spanish Society of Cardiology Clinical Practice Guidelines on High Blood Pressure in January 2000, a new body of scientific evidence has been obtained that needs to be taken into account in clinical practice. A complete clinical evaluation by assessment of the global cardiovascular risk score should be done in patients with hypertension. In this connection, ECG findings and urine albumin excretion are of particular value. Up to now, the results of most important clinical trials indicate that the aim should be to normalize blood pressure, with stricter control in patients at higher risk (diabetes, target organ damage or left ventricular hypertrophy). Antihypertensive therapy should be selected on an individual basis, taking in account that patients with certain associated pathologies will benefit more from particular groups of drugs. Those with diabetes or left ventricular hypertrophy seem to benefit from pharmacological block of the renin-angiotensin system, and patients with heart failure from combined therapy with ACE inhibitors plus beta-blockers.

Introducción y objetivos: la fibrilación auricular es un conocido factor de riesgo de mortalidad en diferentes patologías. Sin embargo, los datos publicados en insuficiencia cardiaca descompensada son contradictorios. El objetivo es investigar el impacto en la mortalidad de la fibrilación auricular en pacientes ingresados por insuficiencia cardiaca descompensada, comparativamente con otras causas. Métodos: estudio retrospectivo de cohortes, en el que durante 10 años se reclutó a todos los pacientes que ingresaron por insuficiencia cardiaca descompensada, infarto agudo de miocardio y accidente cerebrovascular, con una mediana de seguimiento de 6,2 años. Resultados: se reclutó a 6.613 pacientes (74 ± 11 años; 54,6% varones); 2.177 con infarto agudo de miocardio, 2.208 con insuficiencia cardiaca descompensada y 2.228 con accidente cerebrovascular. La mortalidad cruda tras el alta de los pacientes con fibrilación auricular e infarto agudo de miocardio (razón de tasas de incidencia, 2,48; p < 0,001) y accidente cerebrovascular (razón de tasas de incidencia, 1,84; p < 0,001) fue superior a aquellos sin fibrilación auricular. En los pacientes con insuficiencia cardiaca descompensada no hubo diferencias (razón de tasas de incidencia, 0,90; p = 0,12). En modelos ajustados, la fibrilación auricular no fue un predictor de mortalidad hospitalaria en función del diagnóstico; sin embargo, sí fue un predictor independiente de mortalidad tras el alta en pacientes con infarto agudo de miocardio (hazard ratio = 1,494; p = 0,001) y accidente cerebrovascular (hazard ratio = 1,426; p < 0,001) no siendo así en pacientes con insuficiencia cardiaca descompensada (hazard ratio = 0,964; p = 0,603). Conclusiones: la fibrilación auricular se comporta como factor de riesgo independiente de mortalidad tras el alta en pacientes con un ingreso previo por infarto agudo de miocardio y accidente cerebrovascular, no así para aquellos con insuficiencia cardiaca descompensada. Introduction and objectives: atrial fibrillation is an independent risk factor for mortality in several diseases. However, data published in acute decompensated heart failure are contradictory. Our objective was to investigate the impact of atrial fibrillation on mortality in patients admitted to hospital for decompensated heart failure compared with those admitted for other reasons. Methods: this retrospective cohort study included all patients admitted to hospital within a 10-year period due to decompensated heart failure, acute myocardial infarction , or ischemic stroke , with a median follow-up of 6.2 years. Results: we included 6613 patients (74 ± 11 years; 54.6% male); 2177 with acute myocardial infarction, 2208 with decompensated heart failure, and 2228 with ischemic stroke. Crude postdischarge mortality was higher in patients with atrial fibrillation hospitalized for acute myocardial infarction (incident rate ratio, 2.48; P < .001) and ischemic stroke (incident rate ratio, 1.84; P < .001) than in those without atrial fibrillation. No differences were found in patients with decompensated heart failure (incident rate ratio, 0.90; P = .12). In adjusted models, atrial fibrillation was not an independent predictor of in-hospital mortality by clinical diagnosis. However, atrial fibrillation emerged as an independent predictor of postdischarge mortality in patients with acute myocardial infarction (hazard ratio, 1.494; P = .001) and ischemic stroke (hazard ratio, 1.426; P < .001), but not in patients admitted for decompensated heart failure (hazard ratio, 0.964; P = .603). Conclusions: atrial fibrillation was as an independent risk factor for postdischarge mortality in patients admitted to hospital for acute myocardial infarction and ischemic stroke but not in those admitted for decompensated heart failure.