Emergency Department Readmission in Elderly Patients After Acute Rhythm or Rate Control Treatment for Atrial Fibrillation.

Atrial fibrillation (AF) is an age-related increasing disease, characterized by a high number of relapses frequently leading the patients to Emergency Department (ED). Despite AF relapses may be clinically heterogeneous, a proper management requires either a fast and effective restore of the sinus rhythm or a satisfactory control of the ventricular rate. Whether the strategy adopted in the ED could affect the course of disease is still debated. Therefore, the aim of our study was to evaluate the number of ED readmission for AF related symptoms and the event-free period in patients older than 70 years previously treated in ED for an AF recurrence, in order to assess a possible relationship with the acute strategy. An overall number of 302 recurrences of AF were drawn randomly, regarding 102 patients (mean age 78 years). We found that 206 cases (68.2%) were treated with rhythm restoration strategy (RR) whereas 96 (31.8%) with rate control strategy (RC). The median following event-free period was 118.6 +/- 15.5 and 212.9 +/- 37.1 days (p < 0.05) for RR and RC strategy, respectively. Within 6 months, 124 (60.1%) out of RR group patients and only 44 (45.8%) out of RC group patients had to be readmitted to ED for AF related symptoms (whether a recurrence or inefficient rate control symptoms) (p< 0.05). This advantage was substantially confirmed (79.1% vs 65.6% respectively, p < 0.05) after a 12 months follow-up. Our results indicate that acute treatment of AF may affect the long-term outcome of the disease and the ED readmission rate of the patient. Ventricular rate control seems to be associated with a longer event-free period if compared to the rhythm control strategy in the elderly patients. This suggests an age-based work-up of patients admitted to the ED, preferentially using ventricular rate control in elderly subjects.