Background: 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.

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation : insights from the REPOSI study / A. Nobili, V. Raparelli, L. Napoleone, P..M. Mannucci, G.Y.H. Lip, L. Pasina, C. Franchi, M. Marcucci, T.K. Eldin, M.P.D. Di Blanca, F. Perticone, F. Salerno, S. Corrao, D. Prisco, E. Silvestri, C. Cenci, G. Emmi, G. Biolo, G. Guarnieri, M. Zanetti, G. Fernandes, M. Vanoli, G. Grignani, G. Casella, M. Bernardi, S.L. Bassi, L. Santi, G. Zaccherini, E. Mannarino, G. Lupattelli, V. Bianconi, F. Paciullo, R. Nuti, R. Valenti, M. Ruvio, S. Cappelli, A. Palazzuoli, T. Salvatore, F.C. Sasso, D. Girelli, O. Olivieri, T. Matteazzi, M. Barbagallo, L. Plances, R. Alcamo, G. Licata, L. Calvo, M. Valenti, M. Zoli, R. Arnò, F.L. Pasini, P.L. Capecchi, M. Bicchi, G. Palasciano, M.E. Modeo, M. Peragine, F. Pappagallo, R.C. DI GENNARO, A. Postiglione, M.R. Barbella, F. De Stefano, M.D. Cappellini, D. Maria, G. Fabio, S. Seghezzi, M.M. De Amicis, D. Mari, P.D. Rossi, B.B. Ottolini, S. Pugliese, M..V. Lenti, D. Padula, G. Murialdo, A. Marra, F. Cattaneo, M.B. Secchi, D. Ghelfi, L. Anastasio, L. Sofia, M. Carbone, G. Davì, M.T. Guagnano, S. Sestili, G. Mancuso, D. Calipari, M. Bartone, M.R. Meroni, P.C. Perin, B. Lorenzati, G. Gruden, G. Bruno, C. Amione, P. Fornengo, R. Tassara, D. Melis, L. Rebella, V. Pretti, M.S. Masala, L. Bolondi, L. Rasciti, I. Serio, F.R. Fanelli, A. Amoroso, A. Molfino, E. Petrillo, G. Zuccalà, F. Franceschi, G. De Marco, C. Chiara, S. Marta, G. Romanelli, G. Delitala, D. Chiesa, A. Picardi, U.V. Gentilucci, P. Gallo, G. Annoni, M. Corsi, S. Zazzetta, G. Bellelli, F. Arturi, E. Succurro, M. Rubino, G. Sesti, P. Loria, M.A. Becchi, G. Martucci, A. Fantuzzi, M. Maurantonio, S. Carta, S. Atzori, M.G. Serra, M.A. Bleve, L. Gasbarrone, M.R. Sajeva, A. Brucato, S. Ghidoni, P. Di Corato, G. Agnelli, E. Marchesini, F. Fabris, M. Carlon, A. Baritusso, R. Manfredini, C. Molino, M. Pala, F. Fabbian, B. Boari, A. De Giorgi, G. Paolisso, M.R. Rizzo, M.T. Laieta, G. Rini, P. Mansueto, I. Pepe, C. Borghi, E. Strocchi, V. De Sando, C. Sabbà, F.S. Vella, P. Suppressa, R. Valerio, C. Capobianco, L. Fenoglio, C. Bracco, A.V. Giraudo, E. Testa, C. Serraino, S. Fargion, P. Bonara, G. Periti, M. Porzio, F. Peyvandi, A. Tedeschi, R. Rossio, V. Monzani, V. Savojardo, C. Folli, M. Magnini, G.M.L. Gobbo, C.L. Balduini, G. Bertolino, S. Provini, F. Quaglia, F. Dallegri, L. Ottonello, L. Liberale, W.S. Chin, L. Carassale, S. Caporotundo, G. Traisci, L. De Feudis, S. Di Carlo, N.L. Liberato, A. Buratti, T. Tognin, G.B. Bianchi, S. Giaquinto, F. Purrello, A. Di Pino, S. Piro, R. Rozzini, L. Falanga, G. Montrucchio, E. Greco, P. Tizzani, P. Petitti, A. Perciccante, A. Coralli, R. Salmi, P. Gaudenzi, S. Gamberini, A. Semplicini, L. Gottardo, G. Vendemiale, G. Serviddio, R. Forlano, C. Masala, A. Mammarella, S. Basili, L. Perri, R. Landolfi, M. Montalto, A. Mirijello, C. Vallone, M. Bellusci, D. Setti, F. Pedrazzoli, L. Guasti, L. Castiglioni, A. Maresca, A. Squizzato, M. Molaro, M. Bertolotti, C. Mussi, M.V. Libbra, A. Miceli, E. Pellegrini, L. Carulli, A. Sciacqua, M. Quero, C. Bagnato, R. Corinaldesi, R. De Giorgio, M. Serra, V. Grasso, E. Ruggeri, A. Salvi, R. Leonardi, C. Grassini, I. Mascherona, G. Minelli, F. Maltese, A. Gabrielli, M. Mattioli, W. Capeci, G.P. Martino, S. Messina, R. Ghio, S. Favorini, A.D. Col, S. Minisola, L. Colangelo, A. Afeltra, P. Alemanno, B. Marigliano, P. Castellino, J. Blanco, L. Zanoli, M. Cattaneo, P. Fracasso, M.V. Amoruso, V. Saracco, M. Fogliati, C. Bussolino, V. Durante, G. Eusebi, D. Tirotta, F. Mete, M. Gino, A. Cittadini, M. Arcopinto, A. Salzano, E. Bobbio, A.M. Marra, D. Sirico, G. Moreo, F. Scopelliti, F. Gasparini, M. Cocca, R.D. Nieves, M.M. Alberto, A.R. Pedro, L.P. Vanessa, T. Lara, C.V. Xavier, F. Francesc, D.M. Jesus, B.T. Esperanza, D.C. Behamonte Esther, S.P. Maria, M. Romero, P.L. Blanca, L.G. Cristina, V.G.M. Victoria, L. Saez, J. Bosco, S.B. Susana, A.G. Marta, G.B. Concepcion, F.M. Antonio, M.G. Hernandez, M.P. Borrego, P.C. Raquel, P.R. Florencia, G.O. Beatriz, C.G. Sara, G. Cervellera Alfonso, P.M. Marta, R.C. Alberto, A.A. Antonio, G.G. Montserrat, B.R. Miguel Ángel, M.J. Manuel, N.V. Ignacio, A.S. Lucía, L. Alfonso, R.B. David, I.V. Iria, R.P. Monica. - In: CLINICAL RESEARCH IN CARDIOLOGY. - ISSN 1861-0684. - 105:11(2016), pp. 912-920. [10.1007/s00392-016-0999-4]

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation : insights from the REPOSI study

P..M. Mannucci;C. Franchi;M. Marcucci;G. Licata;R.C. DI GENNARO;M.D. Cappellini;G. Fabio;S. Seghezzi;D. Mari;M..V. Lenti;D. Padula;D. Melis;G. De Marco;G. Romanelli;P. Gallo;G. Annoni;A. Brucato;S. Ghidoni;S. Fargion;M. Porzio;F. Peyvandi;A. Tedeschi;R. Rossio;V. Monzani;V. Savojardo;M. Magnini;G.M.L. Gobbo;G. Bertolino;F. Quaglia;R. Leonardi;P. Fracasso;F. Gasparini;F. Salerno;M. Proietti
2016

Abstract

Background: 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.
Antithrombotic therapy; Atrial fibrillation; Elderly; Guidelines; Outcomes; Age Factors; Aged; Aged, 80 and over; Atrial Fibrillation; Chi-Square Distribution; Female; Fibrinolytic Agents; Guideline Adherence; Humans; Italy; Kaplan-Meier Estimate; Logistic Models; Male; Practice Patterns, Physicians'; Proportional Hazards Models; Registries; Risk Assessment; Risk Factors; Thromboembolism; Time Factors; Treatment Outcome; Practice Guidelines as Topic; Cardiology and Cardiovascular Medicine
Settore MED/09 - Medicina Interna
Settore BIO/14 - Farmacologia
Settore MED/01 - Statistica Medica
2016
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