Choice and outcomes of rate control versus rhythm control in elderly patients with atrial fibrillation: a report from the REPOSI study
| Title: | Choice and outcomes of rate control versus rhythm control in elderly patients with atrial fibrillation: a report from the REPOSI study |
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| Authors: | Paciullo, Francesco; Proietti, Marco; Bianconi, Vanessa; Nobili, Alessandro; Pirro, Matteo; Mannucci, Pier Mannuccio; Lip, Gregory Y H; Lupattelli, Graziana; REPOSI Investigators (Mannucci PM; Nobili A; Tettamanti M; Pasina L; Franchi C; Perticone F; Salerno F; Corrao S; Marengoni A; Licata G; Violi F; Corazza GR; Marcucci M; Eldin TK; Di Blanca MPD; 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 EA; Bernardi M; Bassi SL; Santi L; Zaccherini G; Mannarino E; Lupattelli G; Bianconi V; Paciullo F; Nuti R; Valenti R; Ruvio M; Cappelli S; Palazzuoli A; Salvatore T; Sasso FC; Girelli D; Olivieri O; Matteazzi T; Barbagallo M; Plances L; Alcamo R; Calvo L; Valenti M; Zoli M; Arnò R; Pasini FL; Capecchi PL; Bicchi M; Palasciano G; Modeo ME; Peragine M; Pappagallo F; Pugliese S; Di Gennaro C; Postiglione A; Barbella MR; De Stefano F; Cappellini MD; Fabio G; Seghezzi S; De Amicis MM; Mancarella M; Mari D; Rossi PD; Damanti S; Ottolini BB; Bonini G; Miceli E; Lenti MV; Padula D; Murialdo G; Marra A; Cattaneo F; Secchi MB; Ghelfi D; Anastasio L; GNOLI, SOFIA LEONCINA; Carbone M; Davì G; Guagnano MT; Sestili S; Mancuso G; Calipari D; Bartone M; Meroni MR; Perin PC; Lorenzati B; Gruden G; Bruno G; Amione C; Fornengo P; Tassara R; Melis D; Rebella L; Delitala G; Pretti V; Masala MS; Pes C; Bolondi L; Rasciti L; Serio I; Fanelli FR; Amoroso A; Molfino A; Petrillo E; Zuccalà G; Franceschi F; De Marco G; Chiara C; Marta S; D'Aurizio G; Romanelli G; Amolini C; Chiesa D; Picardi A; Gentilucci UV; Gallo P; Annoni G; Corsi M; Zazzetta S; Bellelli G; Szabo H; Arturi F; Succurro E; Rubino M; Sesti G; Loria P; Becchi MA; Martucci G; Fantuzzi A; Maurantonio M; Serra MG; Bleve MA; Gasbarrone L; Sajeva MR; 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 MR; Laieta MT; Rini G; Mansueto P; Pepe I; Borghi C; Strocchi E; De Sando V; Pareo I; Sabbà C; Vella FS; Suppressa P; Valerio R; Agosti P; Fontana F; Loparco F; Capobianco C; Fenoglio L; Bracco C; Giraudo AV; 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 CL; Bertolino G; Provini S; Quaglia F; Dallegri F; Ottonello L; Liberale L; Chin WS; Carassale L; Caporotundo S; Traisci G; De Feudis L; Di Carlo S; Liberato NL; Buratti A; Tognin T; Bianchi GB; 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, GIUSEPPINA; 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 MV; 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, Gianfranco; Capeci W; Mattioli M; Martino GP; Biondi L; Ormas M; Pettinari P; Romiti R; Messina S; Cavallaro F; Ghio R; Favorini S; Col AD; Minisola S; Afeltra A; Alemanno P; Marigliano B; Pipita ME; Castellino P; Blanco J; Zanoli L; Cattaneo M; Fracasso P; Amoruso MV; 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; Sirico D; Moreo G; Scopelliti F; Gasparini F; Cocca M; Ballestrero A; Ferrando F; Berra S; Dassi S; Nava MC; Graziella B; Baldassarre S; Fragapani S; Galanti G; Mascherini G; Petri C; STEFANI', Loreta Anna; Girino M; Piccinelli V; Nasso F; Gioffrè V; Pasquale M; Scattolin G; Martinelli S; Turrin M; SECHI, MARIA LAURA; Catena C; Colussi G; Nieves RD; Alberto MM; Pedro AR; Vanessa LP; Lara T; Xavier CV; Francesc F; Jesus DM; Esperanza BT; Esther DCB; Maria SP; Romero M; Blanca PL; Cristina LG; Victoria VGM; Saez L; Bosco J; Susana SB; Marta AG; Concepcion GB; Antonio FM; Hernandez MG; Borrego MP; Raquel PC; Florencia PR; Beatriz GO; Sara CG; Alfonso GC; Marta PM; Garcia SC; Alberto RC; Antonio AA; Montserrat GG; Ángel BRM; Manuel MJ; Ignacio NV; Lucía AS; Alfonso L; David RB; Iria IV; Monica RP) |
| Contributors: | Paciullo, Francesco; Proietti, Marco; Bianconi, Vanessa; Nobili, Alessandro; Pirro, Matteo; Mannucci, Pier Mannuccio; Lip, Gregory Y H; Lupattelli, Graziana; REPOSI Investigators (Mannucci, Pm; Nobili, A; Tettamanti, M; Pasina, L; Franchi, C; Perticone, F; Salerno, F; Corrao, S; Marengoni, A; Licata, G; Violi, F; Corazza, Gr; Marcucci, M; Eldin, Tk; Di Blanca, Mpd; 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, Ea; Bernardi, M; Bassi, Sl; Santi, L; Zaccherini, G; Mannarino, E; Lupattelli, G; Bianconi, V; Paciullo, F; Nuti, R; Valenti, R; Ruvio, M; Cappelli, S; Palazzuoli, A; Salvatore, T; Sasso, Fc; Girelli, D; Olivieri, O; Matteazzi, T; Barbagallo, M; Plances, L; Alcamo, R; Calvo, L; Valenti, M; Zoli, M; Arnò, R; Pasini, Fl; Capecchi, Pl; Bicchi, M; Palasciano, G; Modeo, Me; Peragine, M; Pappagallo, F; Pugliese, S; Di Gennaro, C; Postiglione, A; Barbella, Mr; De Stefano, F; Cappellini, Md; Fabio, G; Seghezzi, S; De Amicis, Mm; Mancarella, M; Mari, D; Rossi, Pd; Damanti, S; Ottolini, Bb; Bonini, G; Miceli, E; Lenti, Mv; Padula, D; Murialdo, G; Marra, A; Cattaneo, F; Secchi, Mb; Ghelfi, D; Anastasio, L; Gnoli, SOFIA LEONCINA |
| Publisher Information: | Springer |
| Publication Year: | 2018 |
| Collection: | Sapienza Università di Roma: CINECA IRIS |
| Subject Terms: | antiarrhythmic agent; anticoagulant agent; antithrombocytic agent; calcium channel blocking agent; digoxin |
| Description: | 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. |
| Document Type: | article in journal/newspaper |
| File Description: | ELETTRONICO |
| Language: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/29564755; info:eu-repo/semantics/altIdentifier/wos/WOS:000430197100008; volume:35; issue:4; firstpage:365; lastpage:373; numberofpages:9; journal:DRUGS & AGING; http://hdl.handle.net/11573/1092572 |
| DOI: | 10.1007/s40266-018-0532-8 |
| Availability: | http://hdl.handle.net/11573/1092572; https://doi.org/10.1007/s40266-018-0532-8 |
| Rights: | info:eu-repo/semantics/closedAccess |
| Accession Number: | edsbas.C2115CDA |
| Database: | BASE |