NSAIDs are associated with increased risk of atrial fibrillation in patients with prior myocardial infarction: a nationwide study

AIMS: Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with increased risk of cardiovascular disease. Yet, the risk of atrial fibrillation (AF) associated with NSAIDs among patients with prior myocardial infarction (MI) has not been examined, and such data could contribute considerably to the risk-benefit assessment of NSAID use in this clinical context. METHODS AND RESULTS: Using nationwide administrative registries in Denmark, we studied patients aged ≥30 years admitted with first-time MI and without prior AF in the period of 1997-2011. Risk of AF associated with NSAID use vs. no NSAID use was analysed by multivariable time-dependent Cox proportional hazard models. Of the 86 496 patients [mean age 66 (SD 13) years; 64% men] included in this study, 44.1% filled at least one NSAID prescription after discharge from MI. During a mean follow-up of 5.3 years, 7831 (8.9%) developed AF. The confidence intervals rate (95% CI) of AF per 100 person-years with NSAID treatment was 2.2 (2.0-2.4) compared with 1.7 (1.6-1.7) without NSAIDs. In the adjusted model, the risk of AF after NSAID treatment increased [Hazard ratio (HR) 1.27 (1.14-1.40)]. An increased risk of AF was seen regardless of the type of NSAID or with short-term (0-14 days) treatment [HR 1.45 (1.24-1.69)]. When the risk of death in patients exposed [crude rate 23.3 (19.7-27.5)] vs. not exposed [crude rate 17.4 (95% CI 16.8-18.1)] to NSAIDs at the time of AF was compared, NSAID use was associated with a poorer prognosis [HR 1.35 (1.14-1.60)]. CONCLUSION: Our study suggests that the use of NSAIDs might be associated with the increased risk of AF in post-MI patients.