Francesco Paciullo1,2, Marco Proietti3, Vanessa Bianconi4, Alessandro Nobili5, Matteo Pirro1, Pier Mannuccio Mannucci6, Gregory Y H Lip3,7, Graziana Lupattelli1. 1. Unit of Internal Medicine, Department of Medicine, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy. 2. Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy. 3. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK. 4. Unit of Internal Medicine, Department of Medicine, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy. v.bianconi.vb@gmail.com. 5. Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. 6. Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Fondazione Cà Granda, Milan, Italy. 7. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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.
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 AFpatients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.
Authors: Raluca Ionescu-Ittu; Michal Abrahamowicz; Cynthia A Jackevicius; Vidal Essebag; Mark J Eisenberg; Willy Wynant; Hugues Richard; Louise Pilote Journal: Arch Intern Med Date: 2012-07-09
Authors: Cyrus R Kumana; Bernard M Y Cheung; Giselle T Y Cheung; Tori Ovedal; Bjorn Pederson; Ian J Lauder Journal: Br J Clin Pharmacol Date: 2005-10 Impact factor: 4.335
Authors: Alexandra Perez; Daniel R Touchette; Robert J DiDomenico; Thomas D Stamos; Surrey M Walton Journal: Pharmacotherapy Date: 2011-06 Impact factor: 4.705
Authors: Denis Roy; Mario Talajic; Stanley Nattel; D George Wyse; Paul Dorian; Kerry L Lee; Martial G Bourassa; J Malcolm O Arnold; Alfred E Buxton; A John Camm; Stuart J Connolly; Marc Dubuc; Anique Ducharme; Peter G Guerra; Stefan H Hohnloser; Jean Lambert; Jean-Yves Le Heuzey; Gilles O'Hara; Ole Dyg Pedersen; Jean-Lucien Rouleau; Bramah N Singh; Lynne Warner Stevenson; William G Stevenson; Bernard Thibault; Albert L Waldo Journal: N Engl J Med Date: 2008-06-19 Impact factor: 91.245
Authors: Meytal Avgil Tsadok; Cynthia A Jackevicius; Vidal Essebag; Mark J Eisenberg; Elham Rahme; Karin H Humphries; Jack V Tu; Hassan Behlouli; Louise Pilote Journal: Circulation Date: 2012-11-02 Impact factor: 29.690
Authors: Gregory Y H Lip; Giuseppe Boriani; Vincenzo L Malavasi; Marco Vitolo; Jacopo Colella; Francesca Montagnolo; Marta Mantovani; Marco Proietti; Tatjana S Potpara Journal: Intern Emerg Med Date: 2021-12-02 Impact factor: 5.472