BACKGROUND: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. DESIGN:We performed an ancillary analysis from the 'Registro Politerapie SIMI' study, enrolling elderly inpatients from internal medicine and geriatric wards. METHODS:We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. RESULTS:Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-1.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26-0.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34-0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively).CONCLUSION: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study

Gruden G.;Bruno G.;Montrucchio G.;
2018-01-01

Abstract

BACKGROUND: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. DESIGN:We performed an ancillary analysis from the 'Registro Politerapie SIMI' study, enrolling elderly inpatients from internal medicine and geriatric wards. METHODS:We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. RESULTS:Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-1.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26-0.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34-0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively).CONCLUSION: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.
2018
35
4
365
373
http://rd.springer.com/journal/40266
Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Comorbidity; Diabetes Mellitus; Female; Heart Failure; Heart Rate; Hospitalization; Humans; Male; Odds Ratio; Polypharmacy; Prevalence
Paciullo F.; Proietti M.; Bianconi V.; Nobili A.; Pirro M.; Mannucci P.M.; Lip G.Y.H.; Lupattelli G.; Tettamanti M.; Pasina L.; Franchi C.; Perticone F.; Salerno F.; Corrao S.; Marengoni A.; Licata G.; Violi F.; Corazza G.R.; Marcucci M.; Eldin T.K.; Di Blanca M.P.D.; Lanzo G.; Astuto S.; Ardoino I.; Cortesi L.; Prisco D.; Silvestri E.; Cenci C.; Emmi G.; Biolo G.; Guarnieri G.; Zanetti M.; Fernandes G.; Chiuch M.; Vanoli M.; Grignani G.; Casella G.; Pulixi E.A.; Bernardi M.; Bassi S.L.; Santi L.; Zaccherini G.; Mannarino E.; Nuti R.; Valenti R.; Ruvio M.; Cappelli S.; Palazzuoli A.; Salvatore T.; Sasso F.C.; Girelli D.; Olivieri O.; Matteazzi T.; Barbagallo M.; Plances L.; Alcamo R.; Calvo L.; Valenti M.; Zoli M.; Arno R.; Pasini F.L.; Capecchi P.L.; Bicchi M.; Palasciano G.; Modeo M.E.; Peragine M.; Pappagallo F.; Pugliese S.; Di Gennaro C.; Postiglione A.; Barbella M.R.; De Stefano F.; Cappellini M.D.; Fabio G.; Seghezzi S.; De Amicis M.M.; Mancarella M.; Mari D.; Rossi P.D.; Damanti S.; Ottolini B.B.; Bonini G.; Miceli E.; Lenti M.V.; Padula D.; Murialdo G.; Marra A.; Cattaneo F.; Secchi M.B.; Ghelfi D.; Anastasio L.; Sofia L.; Carbone M.; Davi G.; Guagnano M.T.; Sestili S.; Mancuso G.; Calipari D.; Bartone M.; Meroni M.R.; Perin P.C.; Lorenzati B.; Gruden G.; Bruno G.; Amione C.; Fornengo P.; Tassara R.; Melis D.; Rebella L.; Delitala G.; Pretti V.; Masala M.S.; Pes C.; Bolondi L.; Rasciti L.; Serio I.; Fanelli F.R.; Amoroso A.; Molfino A.; Petrillo E.; Zuccala G.; Franceschi F.; De Marco G.; Chiara C.; Marta S.; D'Aurizio G.; Romanelli G.; Amolini C.; Chiesa D.; Picardi A.; Gentilucci U.V.; Gallo P.; Annoni G.; Corsi M.; Zazzetta S.; Bellelli G.; Szabo H.; Arturi F.; Succurro E.; Rubino M.; Sesti G.; Loria P.; Becchi M.A.; Martucci G.; Fantuzzi A.; Maurantonio M.; Serra M.G.; Bleve M.A.; Gasbarrone L.; Sajeva M.R.; Brucato A.; Ghidoni S.; Di Corato P.; Agnelli G.; Marchesini E.; Fabris F.; Carlon M.; Turatto F.; Baritusso A.; Amabile A.; Omenetto E.; Scarinzi P.; Manfredini R.; Molino C.; Pala M.; Fabbian F.; Boari B.; De Giorgi A.; Paolisso G.; Rizzo M.R.; Laieta M.T.; Rini G.; Mansueto P.; Pepe I.; Borghi C.; Strocchi E.; De Sando V.; Pareo I.; Sabba C.; Vella F.S.; Suppressa P.; Valerio R.; Agosti P.; Fontana F.; Loparco F.; Capobianco C.; Fenoglio L.; Bracco C.; Giraudo A.V.; Testa E.; Serraino C.; Fargion S.; Bonara P.; Periti G.; Porzio M.; Tiraboschi S.; Peyvandi F.; Tedeschi A.; Rossio R.; Ferrari B.; Monzani V.; Savojardo V.; Folli C.; Magnini M.; Conca A.; Gobbo G.; Pallini G.; Balduini C.L.; Bertolino G.; Provini S.; Quaglia F.; Dallegri F.; Ottonello L.; Liberale L.; Chin W.S.; Carassale L.; Caporotundo S.; Traisci G.; De Feudis L.; Di Carlo S.; Liberato N.L.; Buratti A.; Tognin T.; Bianchi G.B.; Giaquinto S.; Purrello F.; Di Pino A.; Piro S.; Rozzini R.; Falanga L.; Spazzini E.; Montrucchio G.; Greco E.; Tizzani P.; Petitti P.; Perciccante A.; Coralli A.; Salmi R.; Gaudenzi P.; Gamberini S.; Semplicini A.; Gottardo L.; Vendemiale G.; Serviddio G.; Forlano R.; Masala C.; Mammarella A.; Raparelli V.; Basili S.; Perri L.; Landolfi R.; Montalto M.; Mirijello A.; Vallone C.; Bellusci M.; Setti D.; Pedrazzoli F.; Guasti L.; Castiglioni L.; Maresca A.; Squizzato A.; Molaro M.; Bertolotti M.; Mussi C.; Libbra M.V.; Miceli A.; Pellegrini E.; Carulli L.; Veltri F.; Sciacqua A.; Quero M.; Bagnato C.; Colangelo L.; Falbo T.; De Giorgio R.; Serra M.; Grasso V.; Ruggeri E.; Ilaria B.; Salvi A.; Leonardi R.; Grassini C.; Mascherona I.; Minelli G.; Maltese F.; Damiani G.; Capeci W.; Mattioli M.; Martino G.P.; Biondi L.; Ormas M.; Pettinari P.; Romiti R.; Messina S.; Cavallaro F.; Ghio R.; Favorini S.; Col A.D.; Minisola S.; Afeltra A.; Alemanno P.; Marigliano B.; Pipita M.E.; Castellino P.; Blanco J.; Zanoli L.; Cattaneo M.; Fracasso P.; Amoruso M.V.; Saracco V.; Fogliati M.; Bussolino C.; Durante V.; Eusebi G.; Tirotta D.; Mete F.; Gino M.; Cittadini A.; Vigorito C.; Arcopinto M.; Salzano A.; Bobbio E.; Marra A.M.; Sirico D.; Moreo G.; Scopelliti F.; Gasparini F.; Cocca M.; Ballestrero A.; Ferrando F.; Berra S.; Dassi S.; Nava M.C.; Graziella B.; Baldassarre S.; Fragapani S.; Galanti G.; Mascherini G.; Petri C.; Stefani L.; Girino M.; Piccinelli V.; Nasso F.; Gioffre V.; Pasquale M.; Scattolin G.; Martinelli S.; Turrin M.; Sechi L.; Catena C.; Colussi G.; Nieves R.D.; Alberto M.M.; Pedro A.R.; Vanessa L.P.; Lara T.; Xavier C.V.; Francesc F.; Jesus D.M.; Esperanza B.T.; Esther D.C.B.; Maria S.P.; Romero M.; Blanca P.L.; Cristina L.G.-C.; Victoria V.G.M.; Saez L.; Bosco J.; Susana S.B.; Marta A.G.; Concepcion G.B.; Antonio F.M.; Hernandez M.G.; Borrego M.P.; Raquel P.C.; Florencia P.R.; Beatriz G.O.; Sara C.G.; Alfonso G.-C.C.; Marta P.M.; Garcia S.C.; Alberto R.C.; Antonio A.A.; Montserrat G.G.; Angel B.R.M.; Manuel M.J.; Ignacio N.V.; Lucia A.S.; Alfonso L.; David R.B.; Iria I.V.; Monica R.P.
File in questo prodotto:
File Dimensione Formato  
out.pdf

Accesso riservato

Descrizione: PDF editoriale
Tipo di file: PDF EDITORIALE
Dimensione 470.19 kB
Formato Adobe PDF
470.19 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1719146
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 14
  • ???jsp.display-item.citation.isi??? 15
social impact