Atrial fibrillation (AF) is an important risk factor for stroke, cardiovascular disease and all-cause mortality with high prevalence, and appropriate anticoagulant therapy is the core of preventing AF-related stroke. Warfarin is still the main anticoagulant at present, but the therapeutic window of warfarin is narrow, fixed dose of warfarin can easily lead to excessive coagulation or insufficient anticoagulation at the initial stage of treatment. There are few previous clinical studies on overanticoagulation of warfarin.

To analyze the epidemiological and clinical characteristics of overanticoagulation in patients with AF at the initial stage of warfarin anticoagulation therapy, and explore the influencing factors of overanticoagulation.

The study was a single-center retrospective cohort study. A total of 552 patients with AF treated with warfarin 2.5 mg/d admitted to Linyi City's Hospital from January 2017 to December 2022 were included as the study subjects. The clinical data of patients were collected, including age, gender, body mass, type of AF (non-valvular/valvular), comorbidities (hypertension, diabetes, hypoproteinemia, transaminase abnormalities, heart failure), combined medication (number of combined drugs, combined antibiotics, combined amiodarone), the laboratory test results before treatment were also collected, including serum albumin (Alb), serum creatinine (Scr), serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) levels, as well as international normalized ratio (INR) before treatment and INR after 7 days of treatment. Patients were divided into the overanticoagulation group (INR>3.0, n=122) and non-overanticoagulation group (INR≤3.0, n=430) according to whether INR>3.0 after 7 days of warfarin therapy. The data of patients between the two groups were compared, univariate and multivariate Logistic regression analysis was used to explore the influencing factors of overanticoagulation in the initial stage of warfarin anticoagulation therapy.

The age, proportion of female, valvular atrial fibrillation, hypoproteinemia, transaminase abnormalities, number of combined drugs, proportion of combined amiodarone and AST of patients in the overanticoagulation group were higher than those in the non-overanticoagulation group, and the body mass, hypertension, diabetes, Alb and ALT were lower than those in the non-overanticoagulation group (P<0.05). Multivariate Logistic regression analysis showed age≥65 years (OR=1.954, 95%CI=1.243-3.073, P=0.004), body mass≤63 kg (OR=2.967, 95%CI=1.841-4.783, P<0.001), number of combined drugs>5 (OR=1.976, 95%CI=1.175-3.323, P=0.010), and Scr≥91 μmol/L (OR=2.087, 95%CI=1.222-3.561, P=0.007) were independent risk factors for overanticoagulation at the initial stage of warfarin anticoagulation in patients with AF, while diabetes (OR=0.424, 95%CI=0.191-0.939, P=0.034) was a protective factor for overanticoagulation at the initial stage of warfarin anticoagulation therapy in patients with AF.

Age≥65 years, body mass≤63 kg, number of combined drugs>5, Scr≥91 μmol/L may be risk factors for overanticoagulation at the initial stage of warfarin anticoagulation therapy in patients with AF, while diabetes may be a protective factor at the initial stage of warfarin anticoagulation therapy in patients with AF. INR should be closely monitored in patients on warfarin anticoagulation with advanced age, low body mass, multiple drug combinations and elevated Scr level.

Direct oral anticoagulants (DOACs) have gradually replaced the vitamin K antagonist warfarin and become the first line drugs for anticoagulant therapy in patients with non-valvular atrial fibrillation (NVAF), however, the safety and efficacy of DOACs in clinical use require sustained attention.

To promote rational use of DOACs by investigating and analyzing the potentially inappropriate medication (PIM) of DOACs in elderly patients with atrial fibrillation (AF) hospitalized in Cardiology Department.

Beers criteria, DOACs drug inserts and anticoagulant treatment guidelines were integrated to develop the PIM evaluation criteria for DOACs therapy, including criterias for the indication of DOACs for AF, PIM evaluation of DOACs dose matched to renal function, DOACs application in patients with different liver function and PIM evaluation of DOACs drug interaction, evaluation references for age related PIM, body weight related PIM and bleeding risk related PIM. A retrospective analysis was performed to collect elderly NVAF patients from Hospital Information System (HIS) who were admitted to the department of cardiology and received DOACs (rivaroxaban tablets, edoxaban tablets and dabigatran etexilate capsules) therapy from January 2022 to December 2022 in the Second Affiliated Hospital of Zhejiang Chinese Medical University. The target population was screened according to the inclusion and exclusion criteria and evaluated individually according to the PIM evaluation criteria.

A total of 89 elderly NVAF patients were enrolled with an average age of (77.9±8.1) years, and the incidence of PIM was 56.18% (50/89). A total of 58 cases of PIM in the three DOACs, including 47 cases (81.03%) in the rivaroxaban, 6 cases (10.35%) in the edoxaban and 5 cases (8.62%) in the dabigatran etexilate. Sorted by PIM categories, the incidence of renal function-related PIM was 75.86% (44 cases), drug interaction related PIM was 15.52% (9 cases), liver function related PIM was 6.90% (4 cases) and weight related PIM was 1.72% (1 case) .

Anticoagulation treatment with DOACs in elderly patients with NVAF is associated with non-negligible PIM, rivaroxaban-treated patients have the highest incidence of PIM, followed by edoxaban-treated patients, which mainly manifests as renal function related PIM, drug interaction related PIM and liver function related PIM. Therefore, the clinicians need to develop individualized anticoagulation regimens integrating patient-specific conditions in the anticoagulation in elderly patients with NVAF, thereby reducing the PIM of DOACs therapy.

Diabetes mellitus has been a major concern as a common risk factor for cardiovascular disease. Glycated hemoglobin (HbA_1c) variability is an indicator of long-term blood glucose fluctuation. Therefore, it is of great clinical significance to explore the correlation between HbA_1c variability and new-onset atrial fibrillation (AF) in diabetic patients combined with heart failure with preserved ejection fraction (HFpEF) .

To investigate the correlation between HbA_1c variability and new onset AF in type 2 diabetes mellitus (T2DM) patients combined with HFpEF.

The clinical data of 317 T2DM patients combined with HFpEF diagnosed in the Department of Cardiology, the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2019 were retrospectively analyzed. The follow-up was performed until February 2022, with a mean follow-up time of 3.4 years. The included patients were divided into the AF group (34 cases) and non-AF group (283 cases) based on the presence of new-onset AF during the follow-up period. The HbA_1c variability was expressed as standard deviation of HbA_1c measurement (HbA_1c-SD) and HbA_1c coefficient of variation (HbA_1c-CV). Multivariate Cox regression analysis was used to explore the correlation between HbA_1c variability and new-onset AF in T2DM patients combined with HFpEF. The survival curves were plotted by the Kaplan-Meier (K-M) method. The receiver operating characteristic (ROC) curve of HbA_1c variability predicting new-onset AF in T2DM patients combined with HFpEF was plotted.

The HbA_1c-SD and HbA_1c-CV of patients in the AF group were higher than those in the non-AF group (P<0.05). The included patients were divided into the low HbA_1c variability (HbA_1c-SD≤0.34%, HbA_1c-CV≤4.74%) and high HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) groups according to the median of HbA_1c variability. Log-rank test results showed higher incidence of new-onset AF in patients with high HbA_1c variability (P_HbA1c-SD<0.001, P_HbA1c-CV=0.004). Multivariate Cox regression analysis showed that HbA_1c-SD〔HR=2.22, 95%CI (1.37, 3.61), P=0.001〕 and HbA_1c-CV〔HR=1.65, 95%CI (1.01, 2.67), P=0.001〕 were independent influencing factors for new-onset AF in T2DM patients combined with HFpEF. The AUC of HbA_1c-SD for predicting AF in T2DM patients combined with HFpEF was 0.784 〔95%CI (0.713, 0.855), P=0.001〕, with the optimum cutoff value of 0.36%, sensitivity and specificity of 79.4% and 73.1%, respectively. The AUC of HbA_1c-CV for predicting AF in patients with T2DM and HFpEF was 0.694 〔95%CI (0.591, 0.797), P<0.001〕, with the optimal cutoff value of 4.97%, sensitivity and specificity of 73.5% and 72.1%, respectively.

High HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) is independently associated with an increased risk of new-onset AF in T2DM patients combined with HFpEF, with significant clinical value in predicting AF.

The global population disease burden report shows that atrial fibrillation (AF) and chronic kidney disease (CKD) have emerged as the fast-growing causes of death in the last 20 years. The concept of cardiorenal syndrome suggests that AF may increase the risk of new-onset CKD, however, there are few studies related to the increased risk of new-onset CKD with AF at home and abroad, and the interaction with age remains unclear atpresent.

To investigate whether AF increases the risk of new-onset CKD in northern Chinese population.

The population who attended a comprehensive health check-up for the employees of Kailuan Group in Hebei Province from 2006 to 2010 were selected as study subjects. The general information and laboratory test results of the study subjects were collected, and the study subjects were followed up with the final follow-up date of 2020-12-31 and the end point of new-onset CKD. The included patients were divided into AF group (n=368) and non-AF group (n=110 487) according to the presence or absence of AF. The cumulative incidence of new-onset CKD in patients was calculated using the lifetable method. The Kaplan-Meier method was used to plot the survival curves of the cumulative incidence of new-onset CKD in the AF group and the non-AF group. The Log-rank test was used to compare the differences in the cumulative incidence of CKD between the two groups. The multivariate Cox proportional hazard regression model was used to explore the effect of AF on the risk of new-onset CKD.

AF group was higher than non-AF group in age, male proportion, systolic blood pressure level, diastolic blood pressure level, body mass index, the proportions of education level, participation in physical exercise, hypertension, diabetes, taking hypotensive drugs and hypoglycemic drugs, and high-sensitivity C-reactive protein level (P<0.05) . AF group was lower than non-AF group in the proportion of alcohol consumption, total cholesterol, triacylglycerol and low density lipoprotein cholesterinlevels (P<0.05) . There were statistically significant differences in the incidence and cumulative incidence of new-onset CKD between atrial fibrillation group and non-atrial fibrillation group (P<0.05) . Stratifying the study population by age, there were statistically significant differences in the incidence and cumulative incidence of new-onset CKD in the study subjects aged≤65 years (P<0.05) and statistically significant difference in the incidence of new-onset CKD in the study subjects aged>65 years (P<0.05) . The results of the adjusted multivariate Cox proportional hazard regression analysis showed that AF was a risk factor for new-onset CKD in people aged≤65 years〔HR=1.350, 95%CI (1.038, 1.755) , P=0.025〕.

AF is an independent risk factor for new-onset CKD in northern Chinese population, especially for young and middle-aged populationaged≤65 years.

With the aging of the population, the prevalence of atrial fibrillation is increasing year by year. As the "gatekeepers" of community residents' health, grassroots medical staff with a high level of knowledge about atrial fibrillation is particularly important for standardized management of atrial fibrillation.

To analyze the mastery of atrial fibrillation-related knowledge among grassroots medical staff in Fengxian District, Shanghai and its influencing factors, thus, providing a theoretical basis for subsequent training work.

This study is a cross-sectional survey study. From June to July 2021, a systematic sampling method was used to select 1 393 grassroots medical staff as the research objects including general practitioners, nurses, pharmacists, public health physicians and other medical staff (imaging technology/physician, laboratory technician, traditional Chinese medicine doctor and so on) from 21 community health service centers in Fengxian District, Shanghai. This study used a self-developed electronic questionnaire to investigate them. The contents of the questionnaire included general information and knowledge related to atrial fibrillation (basic knowledge about atrial fibrillation, knowledge about anticoagulant therapy and knowledge about rhythm/heart rate control) . This study compared the mastery of atrial fibrillation-related knowledge among grassroots medical staff in different positions, and used univariate Logistic regression, ordinal multiple classification or binary Logistic regression to analyze the influencing factors of grassroots medical staff's mastery of atrial fibrillation-related knowledge.

A total of 1 383 valid questionnaires were recovered, and the valid questionnaire recovery rate was 99.28%. Among 1 383 grassroots medical staff, 506 cases (36.59%) were general practitioners. 54.88% (759/1 383) , 97.69% (1 351/1 383) and 69.63% (963/1 383) failed in the basic knowledge about atrial fibrillation, knowledge about anticoagulation and knowledge about heart rhythm/heart rate control, respectively. There were statistically significant differences in the scores of atrial fibrillation knowledge, anticoagulation knowledge and heart rhythm/heart rate control knowledge among grassroots medical staff in different positions (P<0.05) . Ordinal multiple classification or binary Logistic regression analysis showed that the position as a general practitioner and professional title were the influencing factors of score in the basic knowledge related to atrial fibrillation among grassroots medical staff (P<0.05) . Age and position as a general practitioner were the influencing factors of whether the score in knowledge related to anticoagulation therapy reaches the pass level or above among grassroots medical staff (P<0.05) . The position as a general practitioner, received standardized training and reading the atrial fibrillation guideline within one year were the influencing factors of the score in knowledge related to heart rhythm/heart rate control among grassroots medical staff (P<0.05) .

The mastery of knowledge about atrial fibrillation among grassroots medical staff is generally not ideal, especially the lack of knowledge about anticoagulation therapy. Atrial fibrillation related knowledge training should be especially strengthened for grassroots medical staff who are not general practitioners, have low professional titles, and have not received standardized training.

Global population epidemiology research shows that by 2019, there were 1.28 billion hypertensive patients, and about 59.7 million patients with atrial fibrillation (AF) worldwide. Hypertension greatly increases the risk of AF. And in older hypertensive patients, the incidence of AF will be higher than 60%. Moreover, AF increases the risk of ischemic stroke, heart failure, myocardial infarction, chronic kidney disease and dementia. However, there are few studies on whether AF increases the risk of new-onset myocardial infarction, and whether the risk interacts with age is still unclear in large hypertensive populations.

To examine whether AF increases the risk of new-onset myocardial infarction in hypertensive patients.

Individuals with hypertension were selected as subjects from the employees of Kailuan Group who underwent the medical check-up in Tangshan Gongren Hospital and Kailuan General Hospital from June 2006 to October 2007. General data and laboratory test results of subjects were collected. And all of them were regularly followed up until 2020-12-31. The endpoint event was new-onset myocardial infarction. The finally enrolled cases (n=42 833) included 270 with AF diagnosed by baseline ECG (AF group) and 42 563 without (non-AF group) . The cumulative incidence of myocardial infarction was calculated by the life table method. The survival curve for the cumulative incidence of new-onset myocardial infarction was plotted by Kaplan-Meier method. The difference of the cumulative incidence of myocardial infarction between AF and non-AF groups was compared by Log-rank test. Multivariate Cox proportional hazards regression model was used to investigate the effect of AF on new-onset myocardial infarction in hypertension.

AF group had greater mean age, and lower mean levels of diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol than non-AF group (P<0.05) . There were also statistically differences in the incidence of myocardial infarction and cumulative incidence of new-onset myocardial infarction between the two groups (P<0.05) . After age-stratification, it was found that the differences in the incidence of new-onset myocardial infarction and cumulative incidence of myocardial infarction were statistically significant between those aged ≤60 years with AF and without AF (P<0.05) , but were insignificant between those aged > 60 years with and without AF (P>0.05) . Adjusted multivariate Cox proportional hazards regression analysis showed that AF was a risk factor for new-onset myocardial infarction in hypertensive population〔HR=2.89, 95%CI (1.74, 4.82) , P<0.01〕, and also in hypertensive population aged ≤60 years old〔HR=4.72, 95%CI (2.11, 10.56) , P<0.01〕.

AF is a risk factor for new-onset myocardial infarction in hypertensive population, especially in those ≤60 years old. Active control of blood pressure and treatment of AF are important prevention and treatment measures for new-onset myocardial infarction.

Atrial fibrillation (AF) is a common clinical tachyarrhythmia with high prevalence, and a predisposing factor of stroke. In addition, it has a causal relationship with heart failure (HF) . Treatment options for AF have changed recently owing to the emergence of new drugs. Many investigations are focused on anticoagulant therapies for AF, but relevant multicenter investigations on AF and HF are rare.

To investigate the clinical characteristics and treatment of patients with AF combined with HF in Chongqing, China.

A total of 4 011 patients with AF and HF who were discharged from 21 hospitals in Chongqing in 2018 were included. Data were collected through the electronic medical record system of the hospitals, including sex, age, basic comorbid conditions, type of AF, NYHA class, thromboembolism history, bleeding history, Color Doppler echocardiography results, HF type and use of drugs (including antithrombotic drugs, rhythm/ventricular rate-control drugs, ACEIs/ARBs, cardiotonic drugs) . The risk of thromboembolism and bleeding were assessed using admission CHA₂DS₂-VASc score and HAS-BLED score. Sex, basic comorbid conditions, AF type, NYHA class, admission CHA₂DS₂-VASc score and HAS-BLED score, left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, endpoint events (thromboembolism and bleeding) , HF type, and treatment options were compared across three age groups (<65, 65-75, >75) and across patients by the level of hospitalized hospital (secondary and tertiary) .

In terms of clinical characteristics, the patients had an average age of (74.0±10.6) years, 2 279 (56.8%) were female. The top three prevalent basic comorbid conditions were coronary heart disease (65.1%) , hypertension (51.0%) , and diabetes (17.5%) . 3 346 (83.4%) patients with nonvalvular atrial fibrillation (NVAF) . NYHA class was Ⅲ and Ⅳ in 3 059 patients (76.3%) , thromboembolism events occurred in 531 patients (13.2%) , and bleeding events occurred in 176 patients (4.4%) . In Color Doppler echocardiography results, The average left atrial diameter was (44.12±9.21) mm. The average left ventricular end-diastolic diameter was (48.45±10.06) mm. The average left ventricular ejection fraction was (54.23±11.94) mm. The main type of HF was HF with preserved ejection fraction, accounting for 66.2%. The average CHA₂DS₂-VASc score was (3.9±1.5) points, and the admission CHA₂DS₂-VASc score was positively correlated with age (r=0.589, P<0.001) . The average HAS-BLED score was (1.7±1.0) points. 3 641 (90.8%) patients were at high risk of thromboembolism and 723 (18.0%) patients were at high risk of bleeding. In terms of antithrombotic treatment, the overall prevalence of anticoagulation treatment was 47.1%, warfarin was the main anticoagulant (37.8%) , the prevalence of use of the new oral anticoagulant was only 9.3%. The overall prevalence of antiplatelet treatment was 44.6%, most of them were monoclonal antiplatelet agents (13.2%) . The prevalence of anticoagulation treatment decreased with age (χ²_trend=136.502, P<0.001) , but that of antiplatelet treatment increased with age (χ²_trend=135.730, P<0.001) . The prevalence of anticoagulation treatment, and use of warfarin and new oral anticoagulants in secondary hospitals was significantly lower than that in tertiary hospitals (P<0.001) . A total of 3 162 (78.8%) patients with atrial fibrillation received ventricular rate control. The prevalence of use of beta-blockers, digoxin and ACEIs/ARBs was 61.6%, 17.6%, and 59.7%, respectively.

The majority of patients with AF complicated with HF in Chongqing are elderly, and the proportion of women is relatively high. HFpEF is the main type of atrial fibrillation, and the NYHA classification is mainly classⅢandⅣ. Most were at high risk for thromboembolism, but less than 1/4 were at high risk of bleeding. The prevalence of antithrombotic treatmentin all ages and levels of hospitals was unsatisfactory, and there was a large gap between current treatment and guideline recommendations in improving HF. In view of this, hospitalphysicians should increase their awareness and capability of standardized diagnosis and treatmentregarding AF with HF.

Atrial fibrillation (AF) patients are prone to stroke and peripheral arterial embolism. Studying the pathogenesis of thrombosis formation in AF and providing effective interventions to reduce the risk is an important direction of clinical and basic research on AF.

To investigate the correlation of markers of inflammation and endothelial injury with thrombosis in the left atrium (LA) in AF patients.

Twenty-nine patients with valvular heart disease and 10 patients with coronary heart disease who underwent thoracotomy at the First Affiliated Hospital of Guangxi Medical University from July 2017 to December 2019 were selected, and divided into sinus rhythm group (15 cases) and AF group 〔24 cases, including 12 with left atrial appendage thrombus (LAAT), and 12 without LAAT〕 according to heart rhythm. General demographics were collected. Besides that, other data were also collected, including left atrial diameter (LAD) and left ventricular ejection fraction (LVEF), levels of protein kinase B (AKT), nuclear factor-κ B (NF-κ B), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), IL-8, tumor necrosis factor (TNF-α), endothelin-1 (ET-1), nitric oxide (NO), von Willebrand factor (VWF), intercellular adhesion molecule (ICAM-1) and vascular cell adhesion factor (VCAM-1) in the left atrial blood sample, and calculated thrombus area in patients with AF and LAAT. The relationships of LAD, LVEF, markers of inflammation and endothelial injury with calculated area of thrombus in AF with LAAT patients were analyzed by Pearson correlation.

There were significant differences in LAD and LVEF between sinus rhythm patients and AF patients with or without LAAT (P<0.05). AF patients with and without LAAT had no significant differences in LAD and LVEF (P>0.05). AF patients without LAAT had higher levels of AKT, NF-κB, IL-8, ET-1, ICAM-1 and VCAM-1 and lower NO level in left atrium than patients with sinus rhythm (P<0.05). AF patients with LAAT had higher levels of AKT and hs-CRP, and lower NO level in left atrium than those without (P<0.05). AF patients with and without LAAT had no significant differences in levels of NF-κB, IL-6, IL-8, TNF-α, ET-1, vWF, ICAM-1 and VCAM-1 (P>0.05). The maximum area, minimum area, and average area of the left atrial appendage thrombus in AF patients with LAAT were 4.8 cm², 1.67 cm², and (3.48±0.83) cm², respectively. Pearson correlation analysis showed LAD, LVEF, AKT, NF-κB, hs-CRP, IL-6, IL-8, TNF-α, ET-1, NO, vWF, ICAM-1, and VCAM-1 had no linear correlation with the area of thrombus in AF patients with LAAT (P>0.05) .

Increased levels of markers of inflammation and endothelial injury in left atrium were found in AF patients, which were even more higher when the patients also had LAAT. Detecting the markers of inflammation and endothelial injury in left atrium is helpful to evaluate the thrombus prevalence in AF patients.

Stroke is highly prevalent in patients with atrial fibrillation (AF) , a most common cardiac arrhythmia with high morbidity, and anticoagulation therapy is a key strategy to prevent AF-related stroke. However, there is short of research on the use of anticoagulation therapy in patients with AF in the community.

To explore the prevalence of use of anticoagulation therapy and influencing factors in elderly patients with nonvalvular atrial fibrillation (NVAF) in Shanghai's communities.

A cross-sectional survey design was used. Stratified sampling was used to select elderly patients with AF who received the 2018 annual physical examination at four community health centers in Shanghai during July to December 2019, and they were surveyed using a questionnaire (consisting of three parts: demographics, CHA2DS2-VASc score and ORBIT score) compiled by our research team for collecting information on their AF prevalence and associated medication use, awareness of AF, comorbidities, and complication, as well as risk for stroke and bleeding. Based on the results of the survey, we excluded those without previous AF-related medical experience and valvular AF, then analyzed the prevalence of anticoagulation therapy in those with NVAF. Anticoagulation therapy was recommended for patients at high risk for stroke in accordance with the CHA2DS2-VASc score. Univariate and multivariate Logistic regression analyses were used to identify influencing factors of anticoagulation therapy in NVAF patients at high risk of stroke.

Three hundred and two patients with NVAF were finally included, of whom the prevalence of current use of anticoagulant and antiplatelet drugs was 29.5% (89/302) , and 39.7% (120/302) , respectively, and that of non-use of anticoagulant or antiplatelet drugs was 30.8% (93/302) . By the CHA2DS2-VASc score, 279 of the 302 NVAF patients (92.4%) were assessed with high risk of stroke, among whom the prevalence of current use of anticoagulant and antiplatelet drugs was 30.5% (85/279) , 40.1% (112/279) , respectively, and the rest 29.4% (82/279) did not take anticoagulant or antiplatelet drugs. Univariate Logistic regression analysis demonstrated that age, marital status, type of AF, onset of AF symptoms, duration of AF, prescription of anticoagulants at the first visit for AF, knowledge of the harmfulness of AF, prevalence of hyperlipidemia, and risk of bleeding were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) . Multivariate Logistic regression analysis showed that age, type of AF, prescription of anticoagulants at the first visit for AF, and knowledge of the harmfulness of AF were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) .

The prevalence of the use of anticoagulation therapy in community-living NVAF patients at higher risk of stroke is unsatisfactory, so the use of anticoagulation therapy for this population needs to be further standardized, especially in patients with advanced age and low awareness of the harmfulness of AF.

Atrial fibrillation is the most obvious arrhythmia in medical practice. Atrial fibrillation has been listed as one of the eight fastest-growing causes of death since 1990. Epidemiological investigation shows that the highest incidence of atrial fibrillation is 9% in people over 65 years old and 17% in people over 80 years old; more than 60% of patients with hypertension will develop atrial fibrillation after the age of 60. Atrial fibrillation increases the risk of ischemic stroke, heart failure, chronic kidney disease, cognitive impairment and dementia, but it is unclear whether it increases the risk of new onset myocardial infarction.

To investigate whether atrial fibrillation increases the risk of new onset myocardial infarction.

From June 2006 to October 2007, 96 750 employees of Kailuan Group in Tangshan, Hebei Province (Kailuan population) were selected for the study, including 458 patients with atrial fibrillation (atrial fibrillation group) and 96 292 patients without atrial fibrillation (non atrial fibrillation group) . The general information of patients was recorded, including age, gender, personal history (smoking history, drinking history) , past medical history (hypertension, coronary heart disease, diabetes, dyslipidemia) , anthropometric parameters (weight, height, blood pressure, etc.) . Total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) and fasting blood glucose (FPG) were collected. The patients were followed up every 2 years, respectively, that was from 2008 to 2009, 2010 to 2011, 2012 to 2013, 2014 to 2015, and 2016 to 2017. The median follow-up was 10 years, and the end point was new onset myocardial infarction. Multivariate Cox regression model was used to analyze the effect of atrial fibrillation on new onset myocardial infarction.

(1) There were significant differences in age, body mass index (BMI) , systolic blood pressure (SBP) , LDL-C, FPG, diabetes, smoking, drinking and new onset myocardial infarction between atrial fibrillation group and non atrial fibrillation group (P<0.05) . (2) Multivariate Cox regression analysis showed that atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.841, 95%CI (1.118, 2.869) , P<0.05〕. After adjusting for age and gender (male) , atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.635, 95%CI (1.049, 2.547) , P<0.05〕, after further adjustment for BMI, SBP, LDL-C, FPG, smoking and drinking, atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.381, 95%CI (1.087, 1.573) , P<0.05〕; drinking was the protective factor of new onset myocardial infarction 〔RR=0.664, 95%CI (0.572, 0.770) , P<0.05〕.

Atrial fibrillation is an independent risk factor of new onset myocardial infarction.