| Title: |
Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study |
| Authors: |
Marco Proietti; Alessandro Nobili; Valeria Raparelli; Laura Napoleone; Pier Mannuccio Mannucci; Gregory Y. H. Lip; On behalf of REPOSI investigators; CARULLI, Lucia; BERTOLOTTI, Marco; MUSSI, Chiara |
| Contributors: |
Marco, Proietti; Alessandro, Nobili; Valeria, Raparelli; Laura, Napoleone; Pier Mannuccio, Mannucci; Gregory Y. H., Lip; On Behalf Of Reposi, Investigator; Carulli, Lucia; Bertolotti, Marco; Mussi, Chiara |
| Publisher Information: |
HEIDELBERG |
| Publication Year: |
2016 |
| Collection: |
Archivio della ricerca dell'Università di Modena e Reggio Emilia (Unimore: IRIS) |
| Subject Terms: |
Atrial fibrillation (AF) ,thromboembolism ,antithrombotic prophylaxis |
| Description: |
Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate if antithrombotic prophylaxis according to the 2012 European Society of Cardiology (ESC) guidelines is associated to a lower rate of adverse outcomes. Data were obtained from REPOSI; a prospective observational study enrolling inpatients aged ≥65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed. Results: Among 2535 patients, 558 (22.0 %) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9 % of patients were on guideline-adherent thromboprophylaxis, 6.8 % were overtreated, and 52.3 % were undertreated. Logistic analysis showed that increasing age (p = 0.01), heart failure (p = 0.04), coronary artery disease (p = 0.013), peripheral arterial disease (p = 0.03) and concomitant cancer (p = 0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p = 0.001) and cancer (p < 0.001), and inversely associated with HF (p = 0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p = 0.007) and CV death (p = 0.024) compared to those non-adherent. Kaplan–Meier analysis showed that guideline-adherent patients had a lower cumulative risk for both all-cause (p = 0.002) and CV deaths (p = 0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p = 0.019 and p = 0.006). Conclusions: Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients |
| Document Type: |
article in journal/newspaper |
| File Description: |
ELETTRONICO |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/27245329; info:eu-repo/semantics/altIdentifier/wos/WOS:000386697100003; volume:105; issue:11; firstpage:912; lastpage:920; journal:CLINICAL RESEARCH IN CARDIOLOGY; https://hdl.handle.net/11380/1114753 |
| DOI: |
10.1007/s00392-016-0999-4 |
| Availability: |
https://hdl.handle.net/11380/1114753; https://doi.org/10.1007/s00392-016-0999-4; http://link.springer.com/article/10.1007%2Fs00392-016-0999-4 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.9503D20 |
| Database: |
BASE |