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.
Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study / F. Paciullo, M. Proietti, V. Bianconi, A. Nobili, M. Pirro, P.M. Mannucci, G.Y.H. Lip, G. Lupattelli, M. Tettamanti, L. Pasina, C. Franchi, F. Perticone, F. Salerno, S. Corrao, A. Marengoni, G. Licata, F. Violi, G.R. Corazza, M. Marcucci, T.K. Eldin, M.P.D. Di Blanca, G. Lanzo, S. Astuto, I. Ardoino, L. Cortesi, D. Prisco, E. Silvestri, C. Cenci, G. Emmi, G. Biolo, G. Guarnieri, M. Zanetti, G. Fernandes, M. Chiuch, M. Vanoli, G. Grignani, G. Casella, E.A. Pulixi, M. Bernardi, S.L. Bassi, L. Santi, G. Zaccherini, E. Mannarino, 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, 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, S. Pugliese, C. Di Gennaro, A. Postiglione, M.R. Barbella, F. De Stefano, M.D. Cappellini, G. Fabio, S. Seghezzi, M.M. De Amicis, M. Mancarella, D. Mari, P.D. Rossi, S. Damanti, B.B. Ottolini, G. Bonini, E. Miceli, 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, G. Delitala, V. Pretti, M.S. Masala, C. Pes, 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. D’Aurizio, G. Romanelli, C. Amolini, D. Chiesa, A. Picardi, U.V. Gentilucci, P. Gallo, G. Annoni, M. Corsi, S. Zazzetta, G. Bellelli, H. Szabo, F. Arturi, E. Succurro, M. Rubino, G. Sesti, P. Loria, M.A. Becchi, G. Martucci, A. Fantuzzi, M. Maurantonio, 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, F. Turatto, A. Baritusso, A. Amabile, E. Omenetto, P. Scarinzi, 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, I. Pareo, C. Sabbà, F.S. Vella, P. Suppressa, R. Valerio, P. Agosti, F. Fontana, F. Loparco, C. Capobianco, L. Fenoglio, C. Bracco, A.V. Giraudo, E. Testa, C. Serraino, S. Fargion, P. Bonara, G. Periti, M. Porzio, S. Tiraboschi, F. Peyvandi, A. Tedeschi, R. Rossio, B. Ferrari, V. Monzani, V. Savojardo, C. Folli, M. Magnini, A. Conca, G. Gobbo, G. Pallini, 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, E. Spazzini, 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, V. Raparelli, 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, F. Veltri, A. Sciacqua, M. Quero, C. Bagnato, L. Colangelo, T. Falbo, R. De Giorgio, M. Serra, V. Grasso, E. Ruggeri, B. Ilaria, A. Salvi, R. Leonardi, C. Grassini, I. Mascherona, G. Minelli, F. Maltese, G. Damiani, W. Capeci, M. Mattioli, G.P. Martino, L. Biondi, M. Ormas, P. Pettinari, R. Romiti, S. Messina, F. Cavallaro, R. Ghio, S. Favorini, A.D. Col, S. Minisola, A. Afeltra, P. Alemanno, B. Marigliano, M.E. Pipita, 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, C. Vigorito, M. Arcopinto, A. Salzano, E. Bobbio, A.M. Marra, D. Sirico, G. Moreo, F. Scopelliti, F. Gasparini, M. Cocca, A. Ballestrero, F. Ferrando, S. Berra, S. Dassi, M.C. Nava, B. Graziella, S. Baldassarre, S. Fragapani, G. Galanti, G. Mascherini, C. Petri, L. Stefani, M. Girino, V. Piccinelli, F. Nasso, V. Gioffrè, M. Pasquale, G. Scattolin, S. Martinelli, M. Turrin, L. Sechi, C. Catena, G. Colussi, 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.B. 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.C. Alfonso, P.M. Marta, S.C. Garcia, R.C. Alberto, A.A. Antonio, G.G. Montserrat, B.R.M. Ángel, M.J. Manuel, N.V. Ignacio, A.S. Lucía, L. Alfonso, R.B. David, I.V. Iria, R.P. Monica. - In: DRUGS & AGING. - ISSN 1170-229X. - 35:4(2018 Apr 01), pp. 365-373. [10.1007/s40266-018-0532-8]
Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study
M. Proietti;P.M. Mannucci;C. Franchi;F. Salerno;M. Marcucci;I. Ardoino;E.A. Pulixi;M.D. Cappellini;G. Fabio;S. Seghezzi;M.M. De Amicis;M. Mancarella;D. Mari;S. Damanti;B.B. Ottolini;G. Bonini;M.V. Lenti;M. Carbone;A. Brucato;P. Agosti;S. Fargion;P. Bonara;M. Porzio;F. Peyvandi;A. Tedeschi;R. Rossio;V. Savojardo;M. Magnini;A. Conca;G. Gobbo;G. Pallini;F. Quaglia;R. Leonardi;S. Messina;F. Cavallaro;P. Fracasso;F. Gasparini;M. Pasquale;
2018
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.
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