| Contributors: |
Paciullo, Francesco; Proietti, Marco; Bianconi, Vanessa; Nobili, Alessandro; Pirro, Metteo; Mannuccio Mannucci, Pier; HY Lip, Gregory; Lupattelli, Graziana; Tettamanti, Mauro; Pasina, Luca; Franchi, Carlotta; Perticone, Francesco; Salerno, Francesco; Corrao, Salvatore; Marengoni, Alessandra; Licata, Giuseppe; Violi, Francesco; Roberto Corazza, Gino; Marcucci, Maura; Kamal Eldin, Tarek; Pia Donatella Di Blanca, Maria; Lanzo, Giovanna; Astuto, Sarah; Ardoino, Ilaria; Cortesi, Laura; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Emmi, Giacomo; Biolo, Gianni; Guarnieri, Gianfranco; Zanetti, Michela; Fernandes, Giovanni; Chiuch, Massimiliano; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Alessandro Pulixi, Edoardo; Bernardi, Mauro; Li Bassi, Silvia; Santi, Luca; Zaccherini, Giacomo; Mannarino, Elmo; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Palazzuoli, Alberto; Salvatore, Teresa; Carlo Sasso, Ferdinando; Girelli, Domenico; Olivieri, Oliviero; Matteazzi, Thoma; Barbagallo, Mario; Plances, Lidia; Alcamo, Roberta; Calvo, Luigi; Valenti, Maria; Zoli, Marco; Arnò, Raffaella; Laghi Pasini, Franco; Leopoldo Capecchi, Pier; Bicchi, Maurizio; Palasciano, Giuseppe; Ester Modeo, Maria; Peragine, Maria; Pappagallo, Fabrizio; Pugliese, Stefania; Di Gennaro, Carla; Postiglione, Alfredo; Rosaria Barbella, Maria; De Stefano, Francesco; Domenica Cappellini, Maria; Fabio, Giovanna; Seghezzi, Sonia; Migone De Amicis, Margherita; Mancarella, Marta; Mari, Daniela; Dionigi Rossi, Paolo; Damanti, Sarah; Brignolo Ottolini, Barbara; Bonini, Giulia; Miceli, Emanuela; Vincenzo Lenti, Marco; Padula, Donatella; Murialdo, Giovanni; Marra, Alessio; Cattaneo, Federico; Beatrice Secchi, Maria; Ghelfi, Davide; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Davì, Giovanni; Teresa Guagnano, Maria; Sestili, Simona; Mancuso, Gerardo |
| Description: |
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. |