IIb C Administration of nondihydropyridine calcium antagonists may be considered to slow a rapid ventricular response in patients with ACS and AF only in the absence of significant HF or hemodynamic instability. Synopsis The incidence of AF in patients with ACS ranges from 10% to 21% and increases with patient age and se- verity of myocardial infarction (MI).S7.4-11,S7.4-12 In the Medicare population, AF is associated with increased in-hospital mortality rate (25.3% with AF versus versus 19.1%), and 1-year mortality rate (48.3% ver- With multivariate adjustment, AF re- mains an independent predictor of death: in hospital (odds ratio: 1.21), at 30 days (odds ratio: 1.20), and at 1 year (odds ratio: 1.34).S7.4-12 Patients who devel- op AF during hospitalization have a worse prognosis than those with AF on admission.S7.4-12 Stroke rates are higher in patients with MI and AF than in those without AF (3.1% for those with AF versus 1.3% for those in sinus rhythm).S7.4-11 Thus, AF is an indepen- dent predictor of poor long-term outcome in patients Patients treated for ACS normally require dual- antiplatelet therapy (DAPT) with aspirin plus a plate- receptor inhibitor and may require the ad- dition of warfarin or a NOAC ( triple therapy ) for primary prevention for patients with AF at increased risk of strokeS7.4-3 (Section 4.3.). An option is to con- sider double therapy the use of an oral antico- agulant plus a P2Y12 inhibitor without aspirin.S7.4-3 If triple therapy is used, efforts may be directed to minimize duration of triple therapy to a period of 4 to 6 weeks, as this is the period of greatest risk of stent thrombosis, especially in patients with ACS, such as ST-segment elevation MI. 